Skip to main content
SpringerLink
Log in

Should We Routinely Transfuse Platelet for Immune Thrombocytopenia Patients with Platelet Count Less Than 10 × 109/L Who Underwent Laparoscopic Splenectomy?

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Laparoscopic splenectomy (LS) is considered as the gold standard procedure for patients with immune thrombocytopenia (ITP). In many institutions, platelet counts less than 10 × 109/L contraindicate LS.

Objective

This study aimed to investigate the safety and feasibility of LS for ITP patients with platelet counts less than 10 × 109/L.

Methods

A total of 88 cases of LS were performed for ITP patients from June 2010 to December 2012. The patients were prospectively divided into three groups based on 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 collected 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 experienced more blood loss than those in group 3, but this was not statistically significant. 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 postoperative hospital stay.

Conclusions

It is safe and feasible to perform LS in ITP patients with platelet count less than 10 × 109/L, without platelet transfusion. The indication for platelet transfusion during LS for ITP patients should be the bleeding manifestations due to thrombocytopenia other than low platelet count itself.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Rodeghiero F, Stasi R, Gernsheimer T et al (2009) Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 113:2386–2393

    Article  CAS  PubMed  Google Scholar 

  2. Sampath S, Meneghetti AT, MacFarlane JK et al (2007) An 18-year review of open and laparoscopic splenectomy for idiopathic thrombocytopenic purpura. Am J Surg 193:580–583; discussion 583–584

    Google Scholar 

  3. Schiavotto C, Rodeghiero F (1993) Twenty years experience with treatment of idiopathic thrombocytopenic purpura in a single department: results in 490 cases. Haematologica 78:22–28

    CAS  PubMed  Google Scholar 

  4. Zoghlami-Rintelen C, Weltermann A, Bittermann C et al (2003) Efficacy and safety of splenectomy in adult chronic immune thrombocytopenia. Ann Hematol 82:290–294

    CAS  PubMed  Google Scholar 

  5. Cines DB, Bussel JB (2005) How I treat idiopathic thrombocytopenic purpura (ITP). Blood 106:2244–2251

    Article  CAS  PubMed  Google Scholar 

  6. Delaitre B, Maignien B (1991) Splenectomy by the laparoscopic approach. Report of a case. Presse Med 20:2263

    CAS  Google Scholar 

  7. Bell RL, Reinhardt KE, Cho E et al (2005) A ten-year, single institution experience with laparoscopic splenectomy. J Soc Laparoendosc Surg 9:163–168

    Google Scholar 

  8. Silecchia G, Boru CE, Fantini A et al (2006) Laparoscopic splenectomy in the management of benign and malignant hematologic diseases. J Soc Laparoendosc Surg 10:199–205

    Google Scholar 

  9. Provan D, Stasi R, Newland AC et al (2010) International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 115:168–186

    Article  CAS  PubMed  Google Scholar 

  10. Yang R, Han ZC (2000) Pathogenesis and management of chronic idiopathic thrombocytopenic purpura: an update. Int J Hematol 71:18–24

    CAS  PubMed  Google Scholar 

  11. Chen X, Peng B, Cai Y et al (2011) Laparoscopic splenectomy for patients with immune thrombocytopenia and very low platelet count: is platelet transfusion necessary? J Surg Res 170:e225–e232

    Article  PubMed  Google Scholar 

  12. Ben-Yehuda D, Gillis S, Eldor A (1994) Clinical and therapeutic experience in 712 Israeli patients with idiopathic thrombocytopenic purpura. Israeli ITP Study Group. Acta Haematol 91:1–6

    CAS  Google Scholar 

  13. Herneth AM, Pokieser P, Philipp MO et al (2001) Role of Doppler sonography in the evaluation of accessory spleens after splenectomy. J Ultrasound Med 20:1347–1351

    CAS  PubMed  Google Scholar 

  14. Cai YQ, Zhou J, Chen XD et al (2011) Laparoscopic splenectomy is an effective and safe intervention for hypersplenism secondary to liver cirrhosis. Surg Endosc 25:3791–3797

    Article  PubMed  Google Scholar 

  15. Manoharan A (1991) Treatment of refractory idiopathic thrombocytopenic purpura in adults. Br J Haematol 79:143–147

    Article  CAS  PubMed  Google Scholar 

  16. Stasi R, Stipa E, Masi M et al (1995) Long-term observation of 208 adults with chronic idiopathic thrombocytopenic purpura. Am J Med 98:436–442

    Article  CAS  PubMed  Google Scholar 

  17. Portielje JE, Westendorp RG, Kluin-Nelemans HC et al (2001) Morbidity and mortality in adults with idiopathic thrombocytopenic purpura. Blood 97:2549–2554

    Article  CAS  PubMed  Google Scholar 

  18. Gadenstatter M, Lamprecht B, Klingler A et al (2002) Splenectomy versus medical treatment for idiopathic thrombocytopenic purpura. Am J Surg 184:606–609 discussion 609–610

    Article  PubMed  Google Scholar 

  19. George JN, Woolf SH, Raskob GE et al (1996) Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood 88:3–40

    CAS  PubMed  Google Scholar 

  20. British Committee for Standards in Haematology General Haematology Task F (2003) Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br J Haematol 120:574–596

    Article  Google Scholar 

  21. Keidar A, Feldman M, Szold A (2005) Analysis of outcome of laparoscopic splenectomy for idiopathic thrombocytopenic purpura by platelet count. Am J Hematol 80:95–100

    Article  CAS  PubMed  Google Scholar 

  22. Cines DB, Blanchette VS (2002) Immune thrombocytopenic purpura. N Engl J Med 346:995–1008

    Article  PubMed  Google Scholar 

  23. Neylon AJ, Saunders PW, Howard MR et al (2003) Clinically significant newly presenting autoimmune thrombocytopenic purpura in adults: a prospective study of a population-based cohort of 245 patients. Br J Haematol 122:966–974

    Article  PubMed  Google Scholar 

  24. Stasi R, Evangelista ML, Stipa E et al (2008) Idiopathic thrombocytopenic purpura: current concepts in pathophysiology and management. Thromb Haemost 99:4–13

    CAS  PubMed  Google Scholar 

  25. Cohen YC, Djulbegovic B, Shamai-Lubovitz O et al (2000) The bleeding risk and natural history of idiopathic thrombocytopenic purpura in patients with persistent low platelet counts. Arch Intern Med 160:1630–1638

    Article  CAS  PubMed  Google Scholar 

  26. Vecchio R, Cacciola E, Lipari G et al (2005) Laparoscopic splenectomy reduces the need for platelet transfusion in patients with idiopathic thrombocytopenic purpura. J Soc Laparoendosc Surg 9:415–418

    Google Scholar 

  27. Slichter SJ (2004) Relationship between platelet count and bleeding risk in thrombocytopenic patients. Transfus Med Rev 18:153–167

    Article  PubMed  Google Scholar 

  28. Corash L, Chen HY, Levin J et al (1987) Regulation of thrombopoiesis: effects of the degree of thrombocytopenia on megakaryocyte ploidy and platelet volume. Blood 70:177–185

    CAS  PubMed  Google Scholar 

  29. Harker LA, Slichter SJ (1972) The bleeding time as a screening test for evaluation of platelet function. N Engl J Med 287:155–159

    Article  CAS  PubMed  Google Scholar 

  30. Zhu JH, Wang YD, Ye ZY et al (2009) Laparoscopic versus open splenectomy for hypersplenism secondary to liver cirrhosis. Surg Laparosc Endosc Percutan Tech 19:258–262

    Article  PubMed  Google Scholar 

  31. Kawanaka H, Akahoshi T, Kinjo N et al (2009) Technical standardization of laparoscopic splenectomy harmonized with hand-assisted laparoscopic surgery for patients with liver cirrhosis and hypersplenism. J Hepatobiliary Pancreat Surg 16:749–757

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

Yunqiang Cai, Xubao Liu, and Bing Peng have no conflicts of interest or financial ties to disclose

Author information

Authors and Affiliations

  1. Department of Hepatopancreatobiliary Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan, China

    Yunqiang Cai, Xubao Liu & Bing Peng

Authors
  1. Yunqiang Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xubao Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bing Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bing Peng.

Additional information

Xubao Liu and Bing Peng have contributed equally to this study. The abstract of this study was presented at the SAGES 2014 Annual Meeting, April 2–April 5, 2014, Salt Lake City, UT.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cai, Y., Liu, X. & Peng, B. Should We Routinely Transfuse Platelet for Immune Thrombocytopenia Patients with Platelet Count Less Than 10 × 109/L Who Underwent Laparoscopic Splenectomy?. World J Surg 38, 2267–2272 (2014). https://doi.org/10.1007/s00268-014-2560-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-014-2560-9

Keywords

Search

Navigation