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Management of thrombocytopenic the surgical patient

Jaya Chandrasekhar, Marc Ruel, Donna Nicholson, Marino Labinaz
An 87-year-old man with idiopathic thrombocytopenic purpura and platelet count of 56 × 10(9)/L underwent transesophageal echocardiography (TEE)-guided transcatheter aortic valve implantation using a femoral approach. Post valve deployment, a new pericardial effusion was noted which was successfully drained. Despite this, the patient became hypotensive needing vasopressor support with reaccumulation of pericardial fluid. Emergent sternotomy was performed and a perforation of the right ventricular apex was noted which was sealed with a pledgeted suture...
December 2016: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
Mohamed Abdelfatah
BACKGROUND: Currently, the platelet count threshold for platelet transfusion that is commonly used prior to surgical evacuation of CSDH is 100,000 per microliter. This study is done to show the outcome of the surgical evacuation of CSDH in patients with intractable thrombocytopenia (platelet count which did not reach 100,000 per microliter after platelet transfusions). MATERIAL AND METHODS: This study retrospectively reviewed the admitted patients with symptomatic CSDH and intractable thrombocytopenia in our university hospitals from January 2007 to January 2016...
October 17, 2016: Turkish Neurosurgery
Ying Li, Dawei Zhang, Fanli Hua, Song Gao, Yangjiong Wu, Jianmin Xu
OBJECTIVE: To assess the effect and complications of open splenectomy (OS) for immune thrombocytopenic purpura (ITP) and determine preoperative factors associated with surgical effect. METHODS: This was a retrospective analysis of ITP patients who failed medical therapy and were treated with OS between 1997 and 2014 at the Jinshan Hospital, China. Follow-up was 60 months. Surgical effect was determined from platelet counts and bleeding episodes. Complications were assessed including bleeding episodes...
January 2017: European Journal of Haematology
Matteo Molica, Fulvio Massaro, Giorgia Annechini, Erminia Baldacci, Gianna Maria D'Elia, Riccardo Rosati, Silvia Maria Trisolini, Paola Volpicelli, Robin Foà, Saveria Capria
Selective splenic artery embolization (SSAE) is a nonsurgical intervention characterized by the transcatheter occlusion of the splenic artery and/or its branch vessels using metallic coils or other embolic devices. It has been applied for the management of splenic trauma, hypersplenism with portal hypertension, hereditary spherocytosis, thalassemia and splenic hemangioma. We hereby describe a case of a patient affected by idiopathic thrombocytopenic purpura (ITP) and warm auto-immune hemolytic anemia (AIHA) both resistant to immunosuppressive and biological therapies, not eligible for a surgical intervention because of her critical conditions...
2016: Mediterranean Journal of Hematology and Infectious Diseases
Kenichi A Tanaka, Pulsar Li, Stephen M McHugh, Kathirvel Subramaniam
Perioperative management of thrombocytopenia is often focused on platelet transfusion. However, there are thrombocytopenic cases that are refractory to platelet transfusion as a result of immune response or consumptive coagulopathy. Acuity of the disease may necessitate an invasive procedure despite a grossly abnormal platelet count. We describe a case of severe thrombocytopenia refractory to platelet transfusion and hemostatic management after an urgent pulmonary valve replacement and pulmonary embolectomy...
July 1, 2015: A & A Case Reports
Ariela L Marshall, Katayoon Goodarzi, David J Kuter
BACKGROUND: Thrombopoietin receptor agonists increase platelet (PLT) counts and are approved for the treatment of chronic immune thrombocytopenia (ITP). These agents may also be useful for the management of thrombocytopenia in patients requiring surgical procedures. STUDY DESIGN AND METHODS: We conducted a retrospective review of patients with thrombocytopenia (baseline PLT count, <150 × 10(9) /L) who received romiplostim before planned operative procedures...
October 2015: Transfusion
Kalpalatha K Guntupalli, Nicole Hall, Dilip R Karnad, Venkata Bandi, Michael Belfort
Managing critically ill obstetric patients in the ICU is a challenge because of their altered physiology, different normal ranges for laboratory and clinical parameters in pregnancy, and potentially harmful effects of drugs and interventions on the fetus. About 200 to 700 women per 100,000 deliveries require ICU admission. A systematic five-step approach is recommended to enhance maternal and fetal outcomes: (1) differentiate between medical and obstetric disorders with similar manifestations, (2) identify and treat organ dysfunction, (3) assess maternal and fetal risk from continuing pregnancy and decide if delivery/termination of pregnancy will improve outcome, (4) choose an appropriate mode of delivery if necessary, and (5) optimize organ functions for safe delivery...
October 2015: Chest
Ioannis D Gkegkes, Sarantis Mourtarakos, Christos Iavazzo
BACKGROUND AND OBJECTIVES: The single-incision approach in laparoscopic surgery is a relatively new concept. This systematic review of the literature was performed to appraise the existing clinical evidence concerning the use of the single-incision technique for spleen resection. METHODS: We performed a systematic search of the PubMed and Scopus databases, and the studies retrieved were included in our review. The references of the included studies were also hand searched...
July 2014: JSLS: Journal of the Society of Laparoendoscopic Surgeons
L J Estcourt
Platelet transfusions are used in clinical practice to prevent and treat haemorrhage in thrombocytopenic patients or patients with severe platelet dysfunction. In the UK, and abroad there has been a recent rise in platelet component demand. The three largest patient groups that use platelet components are patients with haematological malignancies (up to 67%), patients receiving cardiac surgery (up to 10%) and patients receiving intensive care (up to 8%). This review has explored some of the factors that may explain this recent trend within these three main groups...
October 2014: Transfusion Medicine
W Jonathan Fillmore, Bryce D Leavitt, Kevin Arce
PURPOSE: To characterize bleeding risk and management of bleeding in thrombocytopenic patients undergoing dental extraction. MATERIALS AND METHODS: This retrospective cohort study included 68 patients with hematologic disease and concomitant thrombocytopenia undergoing dental extractions. The inclusion criterion was a platelet count of 100,000/μL or less at the time of consultation or extraction. Patients using anticoagulation therapy were excluded from the study...
October 2013: Journal of Oral and Maxillofacial Surgery
Ashis Patnaik, Sudhansu S Mishra, Satya B Senapati, Acharya S Pattajoshi
Intracranial hemorrhage is a rare devastating complication of idiopathic thrombocytopenic purpura (ITP), mostly presenting as intraparenchymal or subarachnoid haemorrhage. Isolated chronic subdural haematoma (SDH) is still very rare and the optimal management is unsettled. Spontaneous resolution of chronic SDH in patients with idiopathic thrombocytopenic purpura is possible. We report a case of spontaneous chronic SDH in a patient with ITP with hemiparesis where the haematoma significantly decreased in size with complete resolution of hemiparesis as a result of platelet transfusions and continuing therapy with steroids...
July 2012: Journal of Surgical Technique and Case Report
L Weinberg, J Chang, P Hayward, M Reynolds, J Fernandes
We report a case of thrombotic thrombocytopenic purpura in a woman post mitral valve repair who presented with unexplained thrombocytopenia, intermittent fever, acute renal failure and severe digital ischaemia. The diagnosis of thrombotic thrombocytopenic purpura was confirmed after exclusion of many of the aetiological factors of postoperative digital ischaemia, a positive haemolytic screen and blood film examination which showed schistocytes and fragmented red cells. Plasma ADAMTS-13 activity measured by enzyme-linked immunosorbent assay was reduced...
May 2013: Anaesthesia and Intensive Care
Jin Zhou, Zhong Wu, Zongguang Zhou, Zhiqiang Wang, Yi Liu, Xiang-Yang Huang, Bing Peng
This study aims to investigate the efficacy and safety of laparoscopic splenectomy (LS) in the management of refractory thrombocytopenia associated with systemic lupus erythematosus (SLE). From January 2003 to February 2012, 20 patients underwent splenectomy for thrombocytopenia associated with SLE. Of these, 11 underwent open (SLE-OS group) and 9 underwent laparoscopic splenectomy (SLE-LS group). Another 15 patients with ITP underwent LS (ITP-LS group) were categorized as the control group. Surgical indications, perioperative details, and short- (90 days) and long- (median, 42 months) term hematological outcomes were assessed...
August 2013: Clinical Rheumatology
Nathan T Jaqua, David Finger, Joshua S Hawley
This is a case of a 26-year-old active duty male with a history of idiopathic thrombocytopenic purpura (ITP) and surgical asplenia who presented with a one-week history of fevers, myalgias, arthralgias, and rigors. His evaluation upon presentation was significant for a temperature of 103 degrees F, white blood cell count of 36 K with a granulocytic predominance, and elevated transaminases. He was treated empirically with broad-spectrum antibiotics with concern for a systemic infection with an encapsulated organism...
2012: Case Reports in Medicine
Natalie R Gwilliam, David A Lazar, Mary L Brandt, Donald H Mahoney, David E Wesson, Mark V Mazziotti, Jed G Nuchtern, Timothy C Lee
PURPOSE: Indications and timing for splenectomy in pediatric chronic immune thrombocytopenic purpura (cITP) are controversial because of high spontaneous remission rates and concern for overwhelming postsplenectomy infection. The objective of this study was to assess the risks, costs, and benefits of medical and surgical intervention for children with cITP. METHODS: After receiving institutional review board approval, medical records for all children with cITP who underwent splenectomy from 2002 through 2009 were retrospectively reviewed (n = 22)...
August 2012: Journal of Pediatric Surgery
Linda P Ha, Mark Arrendondo
Venous thromboembolism (VTE) occurs in approximately 10% of patients after splenectomy, particularly splenectomy performed for hematologic abnormalities. Clinicians often fail to recognize this potential complication in the postoperative period, leading to inappropriate anticoagulation prophylaxis and treatment for these patients. The authors discuss the pathophysiologic mechanisms of VTE in patients who undergo splenectomy and offer management strategies for this complication. A case report of a patient who underwent splenectomy for idiopathic thrombocytopenia purpura, with subsequent fatal VTE, highlights the importance of this issue...
May 2012: Journal of the American Osteopathic Association
Satoru Asano, Masuzoh Taneda, Keiichi Katoh, Kenshi Suzuki
We report the successful management of a female patient who developed postoperative thrombotic thrombocytopenic purpura (TTP) after an uneventful laparoscopic oophorocystectomy. The patient underwent uneventful laparoscopic surgery for ovarian cystoma. One hour after completion of surgery, the patient suddenly went into shock, with her blood pressure dropping to 60/40 mmHg. Hemorrhage into the abdominal cavity with an estimated blood loss of 2,000 ml was confirmed by exploratory laparotomy. Initially, anemia and thrombocytopenia were attributed to blood consumption or disseminated intravascular coagulation (DIC)...
October 2012: Journal of Anesthesia
Zhong Wu, Jin Zhou, Prasoon Pankaj, Bing Peng
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 × 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...
December 2011: International Journal of Hematology
Christopher Bibbo, Philip Shawn Hatfield
Heparin-induced thrombocytopenia (HIT) and heparin-induced thrombocytopenia with thrombosis (HITT) syndromes are the result of an adverse reaction to heparin that results in a spectrum of laboratory and end-organ manifestations secondary to thrombosis of both arterial and venous small and large vessels. HITT most often manifests in the extremities as acral ischemia and necrosis, with a spectrum of severity. The lower extremity surgical patient is at risk for deep venous thrombosis, and when exposed to heparin products, is also at risk for the development of a heparin-induced thrombocytopenic syndrome...
January 2011: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Ramón K Sotomayor-Ramírez
BACKGROUND: Laparoscopic splenectomy has advantages over conventional surgery mainly related to the smaller incision, less postoperative pain and shorter recovery period. The aim of this study was to assess the outcomes of patients with diseases of the spleen managed by elective laparoscopic splenectomy. METHODS: Retrospective review of medical charts was performed of patients who underwent laparoscopic splenectomy by a single surgeon during a three year period...
April 2009: Boletín de la Asociación Médica de Puerto Rico
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