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 (p = 0.07), intraoperative blood loss (p = 0.75), postoperative complications (p = 0.23) and hospital stay (p = 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.
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Rodeghiero F (2008) First-line therapies for immune thrombocytopenic purpura: re-evaluating the need to treat. Eur J Haematol Suppl 80:19–26
Cordera F, Long KH, Nagorney DM, McMurtry EK, Schleck C, Ilstrup D, Donohue JH (2003) Open versus laparoscopic splenectomy for idiopathic thrombocytopenic purpura: clinical and economic analysis. Surgery 134:45–52
Vecchio R, Cacciola E, Lipari G, Privitera V, Polino C, Cacciola R (2005) Laparoscopic splenectomy reduces the need for platelet transfusion in patients with idiopathic thrombocytopenic purpura. JSLS 9:415–418
Silecchia G, Boru CE, Fantini A, Raparelli L, Greco F, Rizzello M et al (2006) Laparoscopic splenectomy in the management of benign and malignant hematologic diseases. JSLS 10:199–205
Keidar A, Sagi B, Szold A (2003) Laparoscopic splenectomy for immune thrombocytopenic purpura in patients with severe refractory thrombocytopenia. Pathophysiol Haemost Thromb 33:116–119
Chen X, Peng B, Cai Y, Zhou J, Wu Z, Chen S (2011) Laparoscopic splenectomy for patients with immune thrombocytopenia and very low platelet count: is platelet transfusion necessary? J Surg Res 170:e225–e232
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
Wu Z, Zhou J, Pankaj P, Peng B (2011) Laparoscopic splenectomy for immune thrombocytopenia (ITP) patients with platelet counts lower than 1 × 109 L. Int J Hematol 94:533–538
Wanachiwanawin W, Piankijagum A, Sindhvananda K, Vathanophas V, Visudhiphan S, Na-Nakorn S (1989) Emergency splenectomy in adult idiopathic thrombocytopenic purpura. A report of seven cases. Arch Intern Med 149:217–219
Stiemer B, Opri F, Senger D, Kreuser ED, Berdel W, Hopp H et al (1996) Successful emergency splenectomy during pregnancy in a patient with life-threatening idiopathic thrombocytopenia case report. J Perinat Med 24:703–706
Pastore Y, Wacker P, Ozsahin H, Humbert J, Hanquinet S, Lironi A (1999) Emergency splenectomy in the management of intracranial hemorrhage in childhood immune thrombocytopenic purpura. J Pediatr Hematol Oncol 21:306–307
Yoneoka Y, Tokita K, Yamauchi JI, Takeda N, Ohta H, Shindo T (2004) Successful management of spontaneous intracranial haemorrhage despite critical thrombocytopenia (platelets < 1000 mm3) due to adolescence-onset idiopathic thrombocytopenic purpura. Acta Neurochir 146:199–201
Dindo D, Demartines N, Clavien P (2004) Classification of surgical complications a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Qu Y, Xu J, Jiao C, Cheng Z, Ren S (2014) Long-term outcomes of laparoscopic splenectomy versus open splenectomy for idiopathic thrombocytopenic purpura. Int Surg 99:286–290
Winslow ER, Brunt LM (2003) Perioperative outcomes of laparoscopic versus open splenectomy: a meta-analysis with an emphasis on complications. Surgery 134:647–653 discussion 654–655
Cai Y, Liu X, Peng B (2014) 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
Szold A, Kais H, Keidar A, Nadav L, Eldor A, Klausner JM (2002) Chronic idiopathic thrombocytopenic purpura (ITP) is a surgical disease: long term results in 100 patients. Surg Endosc 16:155–158
Delaitre B, Blezel E, Samama D, Barrat C, Gossot D, Bresler L et al (2002) Laparoscopic splenectomy for idiopathic thrombocytopenic purpura. Surg Laparosc Endosc Percutaneous Tech 12:412–419
George JN, Woolf SH, Raskob GE, Wasser JS, Aledort LM, Ballem PJ et al (1996) Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood 88:3–40
British Committee for Standards in Haematology General Haematology Task Force (2003) Guidelines for the investigation and management of idiopathic thrombocytopenic Purpura in adults, children and in pregnancy. Br J Haematol 120:574–596
Kam PC (2008) Anesthetic management of a patient with thrombocytopenia. Curr Opin Anesthesiol 21:369–374
Martin Arnau B, Turrado Rodriguez V, Tartaglia E, Bollo Rodriguez J, Targarona EM, Trias Folch M (2016) Impacto delrecuentoplaquetariopreoperatorio en la evolución perioperatoriatras la esplenectomía laparoscópicapor purpura trombocitopénica idiopática. Cir Esp 94:399–403 (English translation available)
Sadowitz D, Terndrup TE (1994) Subglottic airway hemorrhage associated with idiopathic thrombocytopenic purpura. Ann Emerg Med 23:591–595
Felbinger TW, Posner M, Eltzschig HK, Kodali BS (2007) Laparoscopic splenectomy in a pregnant patient with immune thrombocytopenic purpura. Int J Obstet Anesth 16:281–283
Trimmings AJ, Walmsley AJ (2009) Anaesthesia for urgent splenectomy in acute idiopathic thrombocytopenic purpura. Anaesthesia 64:226–227
Qin YH, Zhou TB, Su LN, Lei FY, Zhao YJ, Huang WF (2010) The efficacy of different dose intravenous immunoglobulin in treating acute idiopathic thrombocytopenic purpura: a meta-analysis of 13 randomized controlled trials. Blood Coagul Fibrinolysis 21:713–721
Balagué C, Targarona EM, Cerdán G, Novell J, Montero O, Bendahan G et al (2004) Long-term outcome after laparoscopic splenectomy related to hematologic diagnosis. Surg Endosc 18:1283–1287
Katkhouda N, Grant SW, Mavor E, Friedlander MH, Lord RV, Achanta K (2001) Predictors of response after laparoscopic splenectomy for immune thrombocytopenic purpura. Surg Endosc 15:484–488
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All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Gupta, S., Kalayarasan, R., Chandrasekar, S. et al. Laparoscopic Splenectomy for Immune Thrombocytopenic Purpura (ITP) Patients with Very Severe Thrombocytopenia. Indian J Hematol Blood Transfus 34, 535–539 (2018). https://doi.org/10.1007/s12288-017-0902-0
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DOI: https://doi.org/10.1007/s12288-017-0902-0