Preoperative Measures for ITP Patients Undergoing Splenectomy
Required Preoperative Vaccinations
- The American Society of Hematology recommends polyvalent pneumococcal vaccine, meningococcal C conjugate vaccine, and Haemophilus influenzae b (Hib) vaccine to protect against encapsulated organisms at least 4 weeks before surgery 1
Preoperative Testing and Evaluation
- Patients with ITP should be tested for HCV and HIV infection, as these can cause secondary ITP and may influence management decisions 2, 3
- Screening for H. pylori infection should be considered, as eradication therapy should be administered if positive before proceeding with splenectomy 4, 5
- Further investigations should be performed if there are abnormalities in the blood count or smear (other than thrombocytopenia or findings of iron deficiency) 2, 4
- A bone marrow examination is not necessary in patients presenting with typical ITP 2, 3
Preoperative Platelet Count Management
- Intravenous immunoglobulin (IVIg) can be used to raise platelet counts before surgery, with a dose of 1 g/kg as a one-time dose, which may be repeated if necessary 2, 4
- Anti-D can be considered as an alternative to IVIg if corticosteroids are contraindicated 2, 4
Surgical Approach Considerations
- Both laparoscopic and open splenectomy offer similar efficacy for medically suitable patients 6
- The choice between laparoscopic and open approaches should be based on patient factors and surgeon expertise 6
Patient Education
- Patients should be educated about the risk of post-splenectomy infection and instructed to seek immediate medical attention if fever higher than 101°F (38°C) occurs 1
- Patients should be advised to carry medical alert cards indicating their asplenic status 1