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Case Reports
. 2022 Oct 14;36(1):96-98.
doi: 10.1080/08998280.2022.2126928. eCollection 2023.

Refractory thrombocytopenia during liver transplantation requiring splenectomy

Ivana Wrobleski Wilder  1 , Alexander Reskallah  2 , Catherine M Pivalizza  3 , John S Bynon  4 , Evan G Pivalizza  5
Affiliations
Case Reports

Refractory thrombocytopenia during liver transplantation requiring splenectomy

Ivana Wrobleski Wilder et al. Proc (Bayl Univ Med Cent). .

Abstract

Although thrombocytopenia is common in end-stage liver disease, severe, refractory thrombocytopenia during liver transplantation is rare, and if immune based, usually presents months or years later. This case describes an adult woman in whom preoperative evaluation had not determined an immune-related cause of thrombocytopenia. Clot strength was dramatically impaired as measured by thrombelastography during the transplant. Following a lack of response to repeat platelet transfusions, splenectomy was performed after graft reperfusion with rapid temporal restoration of clot strength. This case shows a severe manifestation of perioperative thrombocytopenia during liver transplantation and clinically guided management when measured clot strength is too low for accurate determination.

Keywords: Liver transplant; splenectomy; thrombelastography; thrombocytopenia.

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Figures

Figure 1.
Figure 1.
Initial TEG 6s after anesthetic induction.
Figure 2.
Figure 2.
TEG 6s trace with fibrinolysis superimposed on poor clot strength.
Figure 3.
Figure 3.
Postsplenectomy TEG 6s with improved clot strength.
See this image and copyright information in PMC

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References

    1. Moore AH. Thrombocytopenia in cirrhosis: a review of pathophysiology and management options. Clin Liver Dis (Hoboken). 2019;20:183–186. doi:10.1002/cld.860. - DOI - PMC - PubMed
    1. Nilles KM, Flamm SL.. Thrombocytopenia in chronic liver disease: new management strategies. Clin Liver Dis. 2020;24(3):437–451. doi:10.1016/j.cld.2020.04.009. - DOI - PubMed
    1. Taylor RM, Bockenstedt P, Su GL, Marrero JA, Pellitier SM, Fontana RJ.. Immune thrombocytopenic purpura following liver transplantation: a case series and review of the literature. Liver Transpl. 2006;12(5):781–791. doi:10.1002/lt.20715. - DOI - PubMed
    1. Takatsuki M, Uemoto S, Kurokawa T, Koshiba T, Inomata Y, Tanaka K.. Idiopathic thrombocytopenic purpura after a living-related liver transplantation. Transplantation. 1999;67(3):479–481. doi:10.1097/00007890-199902150-00023. - DOI - PubMed
    1. Gao W, Song JL, Yang J, Yang JY, Yan LN.. Successful treatment of severe immune thrombocytopenia after orthotopic liver transplant. Exp Clin Transplant. 2018;16(1):103–106. doi:10.6002/ect.2015.0219. - DOI - PubMed

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