During splenectomy in ITP, platelet infusion is given
Indications for splenectomy: 1. Relapsed severe cases after treatment with steroids - for 6 weeks 2. Girls attaining menarche 3. ITP persisting even after 6-9 months refractory to treatment 4. In 2nd trimester pregnancy, with platelet count <10000/mm3 and severe bleeding problems 5. Recurrence after stopping/tapering steroids 6. Profound GI bleed and intracranial bleed Surgery * During surgery and in emergency, fresh blood transfusions or platelet transfusions are required. Sometimes the anti-platelet immune response is temporarily blocked by IgG transfusion so to allow the platelet count to rise at the time of surgery or in cases of severe bleeding or in pregnancy. * Accessory spleen should be identified and removed. * In 7 days platelet count raises to more than 100000/ cu mm. * Laparoscopic approach is ideal in elective splenectomy for ITP. Ref: SRB&;s manual of surgery,3 rd ed, pg no 607
Immediately after ligating dplenic vein
Immediately after removal of spleen
After incision
Next day of surgery
G.I.T