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 × 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.
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