FRCPath Haem Part 1 MCQs-Haemostasis 455

A 47-year-old woman presents with sudden onset left upper quadrant pain radiating to the left shoulder. Contrast-enhanced CT confirms multiple wedge-shaped splenic infarcts without evidence of splenic rupture or abscess. She is haemodynamically stable and afebrile.

Investigations reveal:

• Hb 126 g/L

• Platelets 520 × 10⁹/L

• ECG: Normal sinus rhythm

• JAK2 V617F mutation: Positive

• Antiphospholipid antibodies: Negative

She has no previous history of thrombosis and no contraindication to anticoagulation.

Which of the following is the most appropriate management?

A. Supportive care only with analgesia and hydration, as splenic infarction is usually self-limiting

B. Start broad-spectrum intravenous antibiotics and arrange urgent splenectomy

C. Commence therapeutic anticoagulation while initiating treatment of the underlying myeloproliferative neoplasm, with surgery reserved only for complications

D. Perform urgent splenic artery embolisation to prevent progression of infarction

E. Begin dual antiplatelet therapy (aspirin and clopidogrel) instead of anticoagulation

F. Start cytoreduction with dual antiplatelets