Successful perioperative management of a patient with idiopathic thrombocytopenic purpura undergoing emergent appendectomy: Report of a case

Yoshitaka Toyomasu; Rinshun Shimabukuro; Hatsuo Moriyama; Daihiko Eguchi; Koichi Ishikawa; Fumiaki Kishihara; Yasurou Fukuyama; Takashi Matsumata; Erito Mochiki; Hiroyuki Kuwano

doi:10.1016/j.ijscr.2013.05.019

Successful perioperative management of a patient with idiopathic thrombocytopenic purpura undergoing emergent appendectomy: Report of a case

Int J Surg Case Rep. 2013;4(10):898-900. doi: 10.1016/j.ijscr.2013.05.019. Epub 2013 Aug 6.

Authors

Yoshitaka Toyomasu¹, Rinshun Shimabukuro, Hatsuo Moriyama, Daihiko Eguchi, Koichi Ishikawa, Fumiaki Kishihara, Yasurou Fukuyama, Takashi Matsumata, Erito Mochiki, Hiroyuki Kuwano

Affiliation

¹ Department of General Surgical Science (Surgery I), Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan; Department of Surgery, Nakatsu Municipal Hospital, 173 Shimoikenaga, Nakatsu, Oita 871-8511, Japan. Electronic address: toyomasu@med.gunma-u.ac.jp.

Abstract

Introduction: Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disease characterized by a low platelet count and normal bone marrow. Patients with ITP undergoing surgery are thought to have increased risk for postoperative complications because of their thrombocytopenia.

Presentation of case: we report the case of a 66-year-old woman with ITP who required an emergency operation for acute appendicitis associated with disseminated intravascular coagulation. Preoperative therapy consisted of platelet transfusions only, and intraoperative hemostasis was achieved. Postoperatively, high-dose intravenous immunoglobulin (IVIg) therapy led to an increased, stable, and adequate platelet count and good hemostasis.

Discussion: The outcome of this case suggests that IVIg therapy is not always required for preoperative management of patients with.

Conclusion: IVIg therapy may be useful for postoperative management after emergency surgery.

Keywords: CRP; CT; DIC; Disseminated intravascular coagulation; FDP; ITP; IVIg; Operation; PT/INR; Platelet transfusion; WBC; c-reactive protein; computed tomography; disseminated intravascular coagulation; fibrin degradation products; idiopathic thrombocytopenic purpura; intravenous immunoglobulin; prothrombin time/international normalized ration; white blood cell.