Cardiac surgery in a patient with severe thrombocytopenia: How low is too low?

Abstract

Platelets play a very important role in hemostasis, especially after cardiac surgery. Excessive bleeding after such surgery may lead to increased need for transfusion and its incumbent increase in post-operative morbidity and mortality. Although most cardiac surgeons will offer a surgical option to a patient with moderate thrombocytopenia (platelet count around 70 × 10 9 /L), successful cardiac surgery has not been reported in patients with significantly lower platelets counts (less than 40 × 10 9 /L). We report a case of severe thrombocytopenia (19 × 10 9 /L) where coronary artery bypass grafting was performed with minimal blood loss post-operatively, discuss the patient's management and provide insights while dealing with such patients.

A case of thrombocytopenia associated with the use of hydroxychloroquine following open heart surgery

“…The idiopathic thrombocytopenic purpura, drug-induced thrombocytopenia, infections (rubella), and pseudo-thrombocytopenia are among the causes of thrombocytopenia. 3 …”

Coronary revascularization in a patient with cirrhosis and renal failure. Coronary artery bypass grafting in a patient with hepatic cirrhosis and end stage renal disease

“…Even though platelet counts less than 1 lakh/µL in creases the risk of perioperative bleeding significantly, there have been reports of CABG being done with plate let counts as low as 19 000/cu.mm in cases of ITP [9]. Our patient had stable platelet counts between 60,000-70,000/cu.mm in the preoperative period.…”

Severe thrombocytopenia in tetralogy of Fallot patients: A contraindication for corrective surgery?

“…Most of the reports in the literature of cardiac surgical procedures in patients with low platelet counts have been in the setting of idiopathic thrombocytopenic purpura and heparin-induced thrombocytopenia in adults. [89] There are only few reports of surgery in CCHD with severe thrombocytopenia as in this patient. Olgar et al [10] reported a case of thrombocytopenia (platelet count: 21,000/mm 3 ) in an 8-year-old girl with tricuspid atresia and pulmonary stenosis who underwent a shunt surgery with platelet support, after which the platelet count spontaneously increased to 1.78 lakhs/mm 3 , and there were no hemorrhagic complications noted.…”