Laparoscopic Splenectomy for Patients with Immune Thrombocytopenia and Very Low Platelet Count: Is Platelet Transfusion Necessary?

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). Materials and 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 x 10(9)/L were administered platelet concentrates during surgery, whereas another 20 (group Ib) with PC < 10 x 10(9)/L, 24 (group II) with PC = 10-30 x 10(9)/L and 27 (group III) with PC >= 30 x 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. (C) 2011 Elsevier Inc. All rights reserved.