A patient with ITP has a platelet count of 50000 and is being planned for splenectomy. What is the best time for platelet infusion in this patient
During surgery and in an 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. * The laparoscopic approach is ideal in elective splenectomy for ITP. Treatment for ITP -* Methylprednisolone IV for 3-5 days only * Oral prednisolone tablets--drug of choice for 6-12 weeks * IV immunoglobulin 0.4-1.0 g/kg/day for 5 days only. It competes with antibodies * Vincristine 2 mg/week for 6 weeks * Danazol 200 mg tid * Anti-Rh D antibodies * Azathioprine * Splenectomy * FFP, platelet concentrate, fresh blood transfusions. ref: SRB&;S manual of surgery, ed 3, pg no 608
2 hours before surgery
At the time of skin incision
After ligating the splenic aery
Immediately after removal of spleen
G.I.T