Laparoscopic splenectomy for immune thrombocytopenia (ITP) patients with platelet counts lower than 1 x 109/L

Laparoscopic splenectomy (LS) has become the gold-standard surgical intervention for the treatment of immune thrombocytopenia (ITP) and the patients who experienced medical relapse to steroid. Fewer series are available regarding LS for patients with an extremely low platelet count. The aim of this study is to investigate the feasibility and safety of laparoscopic splenectomy in the treatment of patients with a preoperative platelet count of less than 1 x 109/L. From April 2006 to Jan 2011, 10 patients were managed by laparoscopic splenectomy for idiopathic thrombocytopenia with an extremely low preoperative platelet count. Preoperative, perioperative, and postoperative medical management has been reviewed. Before laparoscopic splenectomy, all of the 10 patients had a platelet count of less than 1 x 109/L but a normal level of coagulation function. Emergency laparoscopic splenectomy was performed. The mean operating time was 157 min; the mean intraoperative blood loss was 44 mL. During the operations, transfusion was provided in two patients. No intraoperative complications ensued. The patients were followed up for a mean of 28 months and showed good recovery without any postoperative complications. Laparoscopic splenectomy is a feasible technique in the treatment of ITP patients, characterized by severe mucocutaneous bleeding, extremely low platelet count, and normal prothrombin time (PT) and activated partial thromboplastin time (APTT).