Should We Routinely Transfuse Platelet for Immune Thrombocytopenia Patients with Extreme Low Platelet Count Who Underwent Laparoscopic Splenectomy?

Yunqiang Cai, PhD, Xubao Liu, PhD, Xin Wang, PhD, Bing Peng, PhD. Department of Hepatopancreatobiliary Surgery, West China Hospital, Sichuan University.

Background: Laparoscopic splenectomy (LS) is considered as the gold standard procedure for patients with immune thrombocytopenia (ITP). In many institutions, low platelet counts (< 30 × 109/L) contraindicated LS. This study aimed to investigate the safety and feasibility of LS for ITP patients with low platelet counts.

Methods: A total of 88 cases of LSs were performed for ITP patients from June 2010 to December 2012. The patients were prospectively divided into three groups according to their immediate preoperative platelet count: < 10 × 109/L (group 1); 10 × 109/L to 30 × 109/L (group 2); and > 30 × 109/L (group 3). We recorded the patients’ demographic characteristics, perioperative details, and platelet count response to surgery.

Results: The patients in the three groups had comparable demographic characteristics. Only one patient in group 1 required conversion (2.4%). The patients in group 1 required more operating time and suffered from more blood loss compared with those in group 3, but not statistically significantly. There were no significant differences between group 2 and group 3 in terms of operating time and blood loss. No statistically significant differences were found between the three groups with regard to complications and post-operative hospital stay.

Conclusions: It is safe and feasible to perform LS in ITP patients, whose platelet counts are extremely low, even without platelet transfusion. The indication for platelet transfusion during LS for ITP patients is the bleeding manifestations due to thrombocytopenia other than extremely low platelet count.

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