Refractory Thrombocytopenia During Liver Transplantation Requiring Splenectomy

Authors

Ivana Wrobleski Wilder
Alexander Reskallah
Catherine M Pivalizza
John S Bynon
Evan G Pivalizza

Publication Date

1-1-2023

Journal

Baylor University Medical Center Proceedings

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

Comments

PMID: 36578624