title: Laparoscopic splenectomy for patients with immune thrombocytopenia and very low platelet count: is platelet transfusion necessary?
abstract: BACKGROUND
  The safe level of platelet count (PC) and necessity for platelet transfusion during laparoscopic splenectomy (LS) remain uncertain in patients with immune thrombocytopenia (ITP).
  
  
  METHODS
  From 2005 to 2010, 81 patients with ITP underwent LS by our surgical team. Of these patients, 10 (group Ⅰa) with preoperative PC < 10 × 10(9)/L were administered platelet concentrates during surgery, whereas another 20 (group Ib) with PC < 10 × 10(9)/L, 24 (group II) with PC = 10-30 × 10(9)/L and 27 (group III) with PC ≥ 30 × 10(9)/L did not receive platelet transfusion. Recently, we carried out comparisons between groups in terms of demographic data and perioperative outcome.
  
  
  RESULTS
  The demographic data were similar among groups. The operative outcome was comparable between group Ia and Ib. Patients in group Ib had significantly lower preoperative PC (P < 0.001) and hemoglobin concentration (P = 0.009), suffered relatively more blood loss (P = 0.151) and drainage exudates (P = 0.151), received more packed red blood cell (RBC) transfusions (P = 0.113) than patients in groups II or Ⅲ. However, blood loss was not correlated with PC (r = -0.145, P = 0.195), but determined by operative time (r =0.610, P < 0.001); and packed RBC transfusion was significantly determined by lower preoperative hemoglobin and conversion to open surgery (OR = 7.2 and 46.7, P < 0.001 and P = 0.005, respectively).
  
  
  CONCLUSIONS
  Very low platelet count should not be contraindicated for LS in ITP patients and perioperative platelet transfusion may be unnecessary.
authors.affiliation: Department of Gastrointestinal Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Chen
authors.forename: Bing
authors.initials: B
authors.lastname: Peng
authors.forename: Yunqiang
authors.initials: Y
authors.lastname: Cai
authors.forename: Jin
authors.initials: J
authors.lastname: Zhou
authors.forename: Yichao
authors.initials: Y
authors.lastname: Wang
authors.forename: Zhong
authors.initials: Z
authors.lastname: Wu
authors.forename: Sirui
authors.initials: S
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D000075202:Contraindications; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D017713:Platelet Transfusion; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000601:surgery* / Q000628:therapy*; D012189:Retrospective Studies; D013156:Splenectomy / Q000379:methods*; D016896:Treatment Outcome; D019564:Unnecessary Procedures; D055815:Young Adult