INTRODUCTION: Essential thrombocytosis (ET) is a disorder that causes persistent increase in the platelet count. Thrombotic and haemorrhagic complications are the main causes of morbidity in ET. We present a case with massive pulmonary embolism related to essential thrombocytosis and treated with streptocynase (STK).
CASE REPORT: A 41 year-old woman presented complaining of progressive dyspnea, cough.The blood pressure 127/70 mmHg, pulse rate 104/minute, respiration rate 30/minute. The heart examination was normal. Pulmonary breath sounds were lowered in the basal of portion both hemitorax. Leukocyte count 16700/mm³ with left shift, hemoglobin 11.4gr/dl, hematocrit 34.8%, platelet count 3384000/mm³, p0² 43 mmHg, pCO² 25 mmHg, sO² 81%, Ph 7,48, D-dimer 1100 ug/ml. The chest X-ray findings were normal. The diagnosis of pulmonary embolism was made on the basis of clinical, laboratory, computorize tomography (CT) findings (filling defects which are thought as embolus in the both right-left pulmonary artery and their segmental branches). Heparin perfusione and aspirine were started. Because of clinical worsening; clopidogrel, diltiazem and STK perfusion were added to therapy. The patient was discharged from the hospital with aspirine, warfarine, clopidogrel, hydroxyurea, allopurinole.
CONCLUSION: We presented a case with massive pulmonary embolism related to ET. In this case, we had to decide whether we would make agressive treatment (expecially thrombolytic therapy) or not. For fatal bleeding complications could occur in ET as well as thrombosis. We presented this case, because we used succesfully thrombolytic agent in the therapy of massive pulmonary embolism related to ET.

Pulmonary embolism Essential thrombocytosis Thrombolytic