Related Experiment Video
Updated: Mar 28, 2026
Application of Laparoscopic Partial Splenectomy with Total Blood Flow Occlusion in Benign Splenic Lesions
Published on: December 20, 2024
Treatment Strategies and Outcomes in Pediatric Patients With Immune Thrombocytopenia Undergoing Surgical Procedures:
Matthew Ross1, Lia Phillips2, Kristyn Pierce3
1NYU Grossman School of Medicine, New York, New York, USA.
Insights
Pediatric immune thrombocytopenia (ITP) management during surgery shows low bleeding risk. Most children received platelet counts over 50×10^9/L, with 52% getting ITP-directed treatments.
Area of Science:
- Pediatric Hematology
- Surgical Management
- Bleeding Disorders
Background:
- Children with immune thrombocytopenia (ITP) face potential perioperative bleeding risks.
- Existing pediatric ITP guidelines lack specific recommendations for surgical settings.
- This study addresses perioperative management and outcomes in pediatric ITP patients.
Purpose of the Study:
- To describe perioperative management strategies for pediatric ITP patients.
- To analyze outcomes based on platelet count, surgery type, and ITP treatments.
- To evaluate the effectiveness of current management practices.
Main Methods:
- Retrospective analysis of pediatric ITP patients (0-24 years).
- Inclusion of surgeries: tooth extraction, tonsillectomy, adenoidectomy, appendectomy, splenectomy.
- Data collected from six US and Canadian centers (2019-2024).
Main Results:
- 61 surgeries were performed on 56 patients; hematology consulted in 89%.
- 52% of surgeries involved perioperative ITP-directed treatment.
- Bleeding events were low (3%), with major bleeding in one untreated patient.
Conclusions:
- Perioperative ITP-directed treatments were given in 52% of pediatric surgeries.
- Treatment was administered to nearly half of patients with initial platelet counts ≥50×10^9/L.
- Current management practices appear to maintain a low perioperative bleeding risk in pediatric ITP.
Introduction:
Children with immune thrombocytopenia (ITP) may have an increased risk of perioperative bleeding. However, current pediatric ITP guidelines do not address this management setting. We aimed to describe perioperative management and outcomes in pediatric patients with ITP by platelet count, type of surgery, and ITP-directed treatment strategies.
Methods:
We conducted a retrospective analysis of patients with ITP ages 0-24 years who underwent tooth extraction, tonsillectomy and adenoidectomy, appendectomy, and/or splenectomy at six centers in the United States and Canada between 2019 and 2024.
Results:
Fifty-six patients underwent 61 surgeries. Hematology was consulted prior to 89% (49/55) of procedures. Perioperative ITP-directed treatment was prescribed for 52% (32/61) of surgeries. Perioperative treatment was prescribed to 83% (15/18) of patients with preoperative platelet counts <50×109/L, compared with 53% (9/17) with platelet counts 50-99×109/L, and 33% (8/24) with platelet counts ≥100×109/L. At the time of surgery, 93% (56/60) of patients had platelet counts ≥50×109/L. There were two perioperative bleeding events (3%; 2/58), including major bleeding in a patient with a platelet count of 1×109/L where hematology was not involved in perioperative management. Medication side effects were reported in 7% (3/43) of patients receiving ITP-directed therapies.
Conclusions:
In this study of 61 surgeries, 52% of pediatric patients with ITP were given perioperative ITP-directed treatments. Treatment was prescribed for almost half of the patients with an initial platelet count ≥50×109/L. Perioperative bleeding risk appears to be low in pediatric ITP under current management practices.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:26Kidney Transplant II: Surgical Procedure
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:25Peptic Ulcer Disease V: Surgical Management and Nursing Care
Surgical Interventions for Peptic Ulcer Disease
01:23Peripheral Artery Disease V: Postoperative Nursing Management