Laparoscopic Splenectomy for Immune Thrombocytopenic Purpura (ITP) Patients with Very Severe Thrombocytopenia

Abstract

Laparoscopic approach is considered as gold standard for splenectomy in patients with Immune Thrombocytopenic purpura (ITP). The evidence for safety and feasibility of laparoscopic splenectomy (LS) in patients with very severe thrombocytopenia (< 10,000 μL) is limited. A retrospective study of 32 ITP patients who underwent LS between July 2012 and November 2016. The ITP patients who had platelet counts < 10,000 μL (Group A, n = 15) and > 10,000 μL (Group B, n = 17) were compared with respect to operative time, blood loss, conversion rate, perioperative blood transfusion, the length of hospital stay and postoperative complications. There was no significant difference between the two groups with respect to operative time ( = 0.07), intraoperative blood loss ( = 0.75), postoperative complications ( = 0.23) and hospital stay ( = 0.15). None of the patients in the two groups required conversion to open procedure. No intra operative blood transfusion was required. In Group A, 3 patients (with platelet count less than 2000 μL) received platelet transfusion at induction of anesthesia while 10 others received after ligation of the splenic artery. There was no difference in the operative time, blood loss, postoperative complications and hospital stay between them. LS is a safe and feasible procedure for ITP patients with very severe thrombocytopenia. In these patients, the timing of intraoperative platelet transfusion does not influence perioperative and anesthetic complications.

Esplenectomía laparoscópica en paciente con síndrome de Evans

“…Debido a esto parece razonable transfundir plaquetas a aquellos pacientes que estarán bajo anestesia endotraqueal con trombocitopenia menor a 50,000/μL. A pesar de esto, se ha publicado una serie de casos de pacientes sin complicaciones durante la manipulación de la vía aérea que presentaban menos de 10,000/μL de plaquetas (6,(10)(11)(12) .…”

Gastric cancer with severe immune thrombocytopenia: A case report

“…The mechanism of ITP includes that PLT membrane proteins become antigenic and stimulate the immune system resulting in thrombocytopenia due to immune-mediated PLT destruction and/or suppression of PLT production[2]. Some studies defined very severe thrombocytopenia as PLT count < 10000/μL[3]; however, some researchers suggest that the severity of the disease is based clinically on bleeding scores rather than a PLT count[4,5]. In this case, the patient presented with gastrointestinal hemorrhage accompanied with acute anemia.…”

Robotic-Assisted Splenectomy by a Modified Lateral Approach: Technique and Outcomes

“…The decision of whether to subject the patient to robotic approach was the surgeon's and patient’s choice. Preoperative platelet transfusion was advocated only selectively based on various clinical and laboratory parameters [ 8 ].…”