Should we routinely transfuse platelet for immune thrombocytopenia patients with platelet count less than 10 × 10⁹/L who underwent laparoscopic splenectomy?
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 × 10(9)/L contraindicate LS.


OBJECTIVE
This study aimed to investigate the safety and feasibility of LS for ITP patients with platelet counts less than 10 × 10(9)/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 × 10(9)/L (group 1); 10 × 10(9)/L to 30 × 10(9)/L (group 2); and > 30 × 10(9)/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 × 10(9)/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.
Department of Hepatopancreatobiliary Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan, China.
Yunqiang
Y
Cai
Xubao
X
Liu
Bing
B
Peng
D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010976:Platelet Count; D017713:Platelet Transfusion; D011446:Prospective Studies; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood* / Q000628:therapy*; D013156:Splenectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult