Page 1 of 1: platelets

anavrin_kaerf · Credits: 4517 My Scrapbook

hi guys this is question which came in all india this year
when should platelets be given during splenectomy of a patient with ITP..
2 hr before
after ligation of splenic artery
after surgery
one more option which i dnt remember..!
whats the answer??and funda??

Akil · Credits: 28144 My Scrapbook

Akil · Credits: 28144 My Scrapbook

Platelet transfused pre operatively survive for LESS than 12 hours! But pre operative transfusion of platelet is also one strategy that has been employed. The others being corticosteroid therapy, IV IgG and peri operative platelet transfusion (after clamping the pedicle). Some authors STRESS that platelet transfusion should be done ONLY after the splenic pedicle is clamped.... and every suggestion is based only on anecdotal evidence.

But by what the question goes, it could be 'after clamping splenic artery' I feel!

anavrin_kaerf · Credits: 4517 My Scrapbook

oh k thanks man...but we cant also refer google books for answers..i mean questions are made from standard text books..dont u think so?

Akil · Credits: 28144 My Scrapbook

Google Books are NOT a class in itself. They are just a marketing feature and even many standard author texts are available there from publishsers (including some Lange texts!).

Concepts do not change! Infact specialty books give more detailed answers, I have seen with the answer to the "whys" and "why nots" explained in detail but in simpler context. General books always run short of space and to keep the size of the volume have to cut down on few things.

Let us remember that the so called standard texts are not always 'self-written' but a compilation of 'references' from pioneering works. Isn't it? These references are not 'owned' by these few books. Any other book could also give the same concept...since they would also follow the same reference.

Unusual insights are got when we actually get to the real source of the information but we won't have the time. But the same insight can be got by reading 'specific' text specially dealing with the topic and such!

We need to use our discretion as to what we can indeed accept and what not! Some google books are 'old' texts perhaps into 1950s etc too! We need to be careful what we refer from.

Coming back to the question:

Well, the idea in this question is simple... If I transfuse platelet preoperative, I am going to lose a few with the spleen as long as blood flows through it. We all know entire blood circulates almost every minute and perhaps in GA, a bit slower but nevertheless the amount lost with spleen must be sizeable making the transfusion useless. On the other hand, very low platelet count could in itself be a surgical risk and hence pre operative platelet transfusion might be considered in few. Dont you think so?

This is my inference and understand... Correct me if I am wrong!

drjanak · Credits: 3151 My Scrapbook

Here is a reference from standard text book of surgery.
Schwartz Principles of Surgery – 8th Edition
Chapter 33 SPLEEN – Platelet Disorders - ITP
“Splenectomy provides a permanent response without subsequent need for steroids in 75 to 85% of the total number of patients undergoing splenectomy (see the "Splenectomy Outcomes" section of this chapter). Responses usually occur within the first postoperative week. Patients with extremely low platelet counts (<10,000/mm3) should have platelets available for surgery, but should not receive them preoperatively. Once the splenic pedicle is ligated, platelets are given to those who continue to bleed.”

Also using the same reference chapter, Akil's conclusion to reach the correct answer is logical. It obviously makes sense not to transfuse platelets and have them sequestered in the spleen which is for removal anyway.
Chapter 33 SPLEEN – Physiology & Pathophysiology
Platelets, on the other hand, generally survive in the circulation for 10 days. Under normal circumstances one third of the total platelet pool is sequestered in the spleen. Thrombocytopenia may result from excessive sequestration of platelets as well as accelerated platelet destruction in the spleen. Splenomegaly may result in sequestration of up to 80% of the platelet pool. The spleen may also contribute to the immunologic alteration of platelets, leading to thrombocytopenia in the absence of splenomegaly (e.g., idiopathic thrombocytopenic purpura [ITP]).

Akil · Credits: 28144 My Scrapbook

So we have indeed got a 'standard' reference

for the same answer...

anavrin_kaerf · Credits: 4517 My Scrapbook

yup thanks guys..!!

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