Splenectomy with low platelets

My daughter, age 21, is scheduled for splenectomy 7/31. Surgeon had said he would like platelets at 100,000 (she hasn't been there since 1/24/12), but would do surgery (laproscopic) at 50,000 (she hasn't been there since 3/1/12). She sees hemotologist 7/26, but I am curious, how do they handle the danger of bleeding with low platelets and surgery. We are currently trying Promacta again and 20 mg prednisone. No surge for the first week. Let's hope we get something this next week.

Did you choose the Splenectomy or did the Dr talk you into it? To my knowledge when a surgery is done one a person with low platelets, they will have Platelet transfusions standing by just in case.

I just had a splenectomy on 7/6. My surgeon said the same thing about the counts...he wanted me at 50K. He also had platelets and blood on hand just in case during the surgery. My counts had been fluctuating but were at 80K just before surgery thankfully and they said I had no problems at all with bleeding, in fact they said it was very minimal. How long has your daughter had ITP?

Last Fall I was faced with a splenectomy with platelets in the 0-6 range. After ten years of managing my ITP w prednisone, this steriod finally failed and no other treatments would raise my numbers.

The surgery would have been done as open surgery - that is, not laparoscopically (which is always a safer method). This is because with laparoscopy, if a bleed occurs behind the camera, it may not be detected. With open surgery, the surgeon can see everything better and potentially control bleeding better. Also I would have had platelet transfusions ready- although my immune system was clearing such platelets quickly, it made sense for the short period of surgery.

Gayk4

Another option we discussed was to embolize the arteries feeding the spleen, then wait for a number of days for it to stop functioning - and then as platelets numbers rose, remove the spleen laparoscopically. We decided we didnt want to take the risk bleeding due to a botched attempt at embolism. Also, if my numbers failed to rise after the spleen was embolized, we would then be committed to take it out, under low numbers and hence open surgery. So we decided to go for the open surgery.

All this became moot because I was a late responder to Nplate and finally responded to doubling doses each week. We used the Nplate-induced high platelet numbers for a laparoscopic splenectomy, instead of deciding to be Nplate-dependent.

This strategy paid off and I'm drug-free now, with values in the 300s.

I wish you and your daughter good luck!

Mark

Thanks for the replies. She has had ITP for over 4 yrs. She has tried: WinRho (twice), IVIG, prednisone (repeatedly), Promacta and 6-MP. The doctor did not push for splenectomy, she mad that decision herself. The doctor said there were 5 more cheomo therapies we could try in addition to the
6-MP, but she decided that she has had enough. Everything stops working after a while with her. We see Hemotologist on 7/26 (5 days before scheduled surgery). Hopefully her counts will have gone up (back on Promacta and increased Prednisone). If not, I want to hear what the plan is.

Your daughter is young so the chances of remission after splenectomy are high. Good luck.

Ann is right--I think the success rate for young splenectomy patients is about 2/3. (I was 63, and mine failed.)

To get me up to 50K for a laproscopic splenectomy (this was in 2004), I took first 30 mg of pred a day and then 80 a day--which took me from 21K to 68K. I also remember the surgeon said they gave splenectomy patients steroids intravenously before the surgery--I assume in case the pred hadn't done the trick. I had donated my own blood for the surgery, but it wasn't needed.

(When I had what my hema calls "BIG surgery"--a knee replacement, the orthopedic surgeon wanted me much higher--like normal numbers. I also increased my pred intake to reach that. I didn't need any of my donated blood for that surgery either. I assume an open splenectomy is "big surgery.")

Ask about the embolism. I assumed it was standard. It was standard for my surgeon anyway. The only real discomfort I endured was after the embolism--I can't imagine one could wait days between the embolism and the surgery--I had maybe an hour, and wow was I ready to go under at that point.

Good Luck!!!