Laparoscopic splenectomy for immune thrombocytopenia in patients with a very low platelet count.

Zychowicz, Anna; Radkowiak, Dorota; Lasek, Anna; Małczak, Piotr; Witowski, Jan; Major, Piotr; Strzałka, Marcin; Kulawik, Jan; Budzyński, Andrzej; Pędziwiatr, Michał

doi:10.5114/wiitm.2018.75847

Cited by 6 publications

(4 citation statements)

References 26 publications

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“…Hematologic intensification of treatment is warranted to increase the platelet count above 50×10 9 /L; if this threshold is not reached, preoperative or intraoperative platelet transfusion becomes necessary. Additionally, early ligation of the splenic artery by the surgeon is crucial to halt platelet destruction within the spleen [ 8 ]. In this context, we monitored serial platelet counts and performed ROTEM assays to assess and ensure proper clot function during the procedure and in the immediate postoperative period.…”

Section: Discussionmentioning

confidence: 99%

Successful kidney transplantation from a live donor with immune thrombocytopenia: a case report

Yang,

Ho,

Lee

et al. 2024

Clin Transplant Res

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Organ transplantation from donors with immune thrombocytopenia (ITP), a condition involving the autoantibody-mediated destruction of platelets, is a topic of debate due to the potential for transplantation-mediated autoimmune thrombocytopenia (TMAT), a rare but potentially fatal complication. Previous reports have described transplants from deceased liver donors with ITP who had very low platelet counts and disease largely refractory to treatment. Here, we present the first case of living kidney transplantation from a donor with ITP who underwent preoperative treatment, with concurrent splenectomy performed to reduce the long-term risk of spontaneous hemorrhage. To ensure the safety of the procedure, we monitored perioperative rotational thromboelastometry parameters and platelet counts, leading to the normalization of the donor's platelet levels. The recipient experienced an uneventful recovery of renal function without perioperative bleeding or the development of TMAT. Our report suggests that kidney transplantation from a donor with well-managed ITP is safe, and such a condition should not be considered a contraindication for donation.

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Section: Discussionmentioning

confidence: 99%

Successful kidney transplantation from a live donor with immune thrombocytopenia: a case report

Yang,

Ho,

Lee

et al. 2024

Clin Transplant Res

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“…The patient with low platelet count receiving preoperatively another course of steroids or IgG or eltrombopag or romiplostim maybe should tried out, which could be validated by prospective trials. The optimal perioperative management, especially for patients with ultra low PLT should be developed, such as hematologist’s assessment for potential treatment strategy, preoperative platelet transfusions preparation, intraoperative platelet transfusions, dissecting and clipping the splenic artery as early in the course of the operation as possible [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Platelet count on preoperative day 1 predicts the long-term responses to laparoscopic splenectomy for Chinese patients with medically refractory idiopathic thrombocytopenic purpura

Liao¹,

Tang²,

Song³

et al. 2018

BMC Surg

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BackgroundLaparoscopic splenectomy (LS) is regarded as a second-line treatment for medically refractory idiopathic thrombocytopenic purpura (ITP), but the predictive factors for the long-term postoperative responses to ITP are still a matter of debate. We aimed to investigate the factors that can predict the long-term response after LS for Chinese patients with medically refractory ITP.MethodsFrom January 2011 to September 2016, 78 Chinese patients with ITP who underwent LS were retrospectively analyzed. Twelve parameters were analyzed by univariate and multivariate methods.ResultsUnivariate analysis revealed that platelet count on preoperative day (PRD) 1 (P < 0.001) and operative time (P = 0.011) were significantly associated with long-term response of ITP after LS. Multivariate analysis revealed that platelet count on PRD 1 was a predictive factor of long-term response (P < 0.001). Furthermore, a long-term, stable response of platelet count on PRD 1 of > 30.0 × 109/L was easier to achieve than a platelet count on PRD 1 ≤ 30.0 × 109/L after LS for ITP.ConclusionsLS is a valuable and effective option in the treatment of medically refractory ITP. Platelet count on PRD 1 is an independent predicting factor for long-term response after LS for Chinese patients with ITP.

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“…Laparoscopic splenectomy (LS) is a promising procedure for treatment of hypersplenism and splenomegaly secondary to portal hypertension, and plays a key role in laparoscopic devascularization [10–13]. It not only provides enough working space for the following devascularization procedure, but also removes the diseased spleen and thus improves the thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic selective esophagogastric devascularization and splenectomy for patients with cirrhotic portal hypertension.

Lin

Liu

Zhiqiang

et al. 2018

Videosurgery and Other Miniinvasive Techniques

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Introduction The role of laparoscopic selective esophagogastric devascularization and splenectomy (LSEGDS) in the treatment of esophagogastric variceal bleeding and hypersplenism in patients with cirrhotic portal hypertension has not been well studied. Aim To investigate the safety and efficacy of LSEGDS for esophagogastric variceal bleeding and hypersplenism in patients with cirrhotic portal hypertension. Material and methods From May 2011 to December 2014, 74 patients with portal hypertension resulting from liver cirrhosis underwent surgery for gastroesophageal variceal bleeding and hypersplenism. Forty-one of these patients underwent laparoscopic esophagogastric devascularization and splenectomy (LEGDS), and the others underwent LSEGDS. A retrospective comparative analysis of clinical data was conducted between the two groups, including clinical characteristics, laboratory data, operative morbidity and mortality, and outcomes of follow-up. Results The operation was completed successfully in all the patients, except that conversion was required in one patient in the LEGDS group. The operating time was similar in both groups (p = 0.579). The intraoperative blood loss was lower in the LSEGDS group (p = 0.011). Postoperative complications showed no significant difference between the two groups regarding mortality rate, pleural effusion, pancreatic injury, pulmonary infection, liver dysfunction, or postoperative abdominal bleeding. Postoperative platelet counts increased significantly more in the LEGDS group than in the LSEGDS group (p = 0.004). There were no significant differences in the long-term follow-up data, such as incidence of rebleeding, portal vein thrombosis, hepatic encephalopathy and survival (p > 0.05). Conclusions The LSEGDS is a safe and effective procedure for management of cirrhotic portal hypertension, especially in patients with visible paraesophageal veins.

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Laparoscopic splenectomy for immune thrombocytopenia in patients with a very low platelet count.

Cited by 6 publications

References 26 publications

Successful kidney transplantation from a live donor with immune thrombocytopenia: a case report

Successful kidney transplantation from a live donor with immune thrombocytopenia: a case report

Platelet count on preoperative day 1 predicts the long-term responses to laparoscopic splenectomy for Chinese patients with medically refractory idiopathic thrombocytopenic purpura

Laparoscopic selective esophagogastric devascularization and splenectomy for patients with cirrhotic portal hypertension.

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