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[Anesthesia for a patient with macrothrombocytopenia]
S Kasama1, M Hayafuji, T Takano
1Department of Anesthesiology, Nagano Red Cross Hospital.
Masui. the Japanese Journal of Anesthesiology
|December 24, 1997
Summary
This study highlights a patient with macrothrombocytopenia who underwent major surgery. Despite low automated platelet counts, normal platelet function and biomass allowed for an uneventful surgical outcome.
Area of Science:
- Hematology
- Surgical Oncology
- Anesthesiology
Background:
- Macrothrombocytopenia is a platelet disorder characterized by enlarged platelets.
- Accurate platelet quantification can be challenging with automated cell counters.
- Surgical risk assessment in patients with platelet disorders requires careful evaluation.
Observation:
- A 56-year-old female presented with macrothrombocytopenia prior to colectomy and hepatectomy.
- Automated platelet counts were low (0.5-1.6 x 10^4/µL), but microscopy revealed a higher count (0.9-3.4 x 10^4/µL) with numerous large platelets.
- Platelet biomass appeared near normal, with normal bleeding time and platelet function tests.
Findings:
- The patient received high-dose gamma-globulin preoperatively and platelet transfusion intraoperatively.
- Combined epidural and general anesthesia was utilized for the surgical procedures.
- The intraoperative and postoperative periods were uneventful, with no significant bleeding complications.
Implications:
- This case suggests that platelet biomass and function may be more critical than automated platelet count in predicting surgical bleeding risk in macrothrombocytopenia.
- Careful preoperative assessment including microscopic examination and functional studies is crucial for managing patients with platelet disorders undergoing major surgery.
- Multimodal anesthetic and perioperative management strategies can ensure patient safety in complex surgical cases involving hematological abnormalities.