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Anaesthetic management of a patient with thrombocytopenia

Kam, Peter CA

Current Opinion in Anesthesiology: June 2008 - Volume 21 - Issue 3 - p 369–374
doi: 10.1097/ACO.0b013e3282faa2db
Anesthesia and medical disease: Edited by François Clergue

Purpose of review New insights into the role of platelets in haemostasis have enabled a better understanding of the pathophysiology of conditions associated with thrombocytopenia. The development of new drugs and the advances in blood transfusion technology have improved the clinical management of patients with thrombocytopenia. The aim of this article is to provide a concise review of major advances in the perioperative management of patients with thrombocytopenia.

Recent findings Thrombocytopenia is a symptom, and the underlying cause must be evaluated. Immunotherapy, corticosteroids, immunosuppressive drugs and thrombopoietic growth factors can increase the number of platelets in thrombocytopenic patients. Further, a better understanding of the pathophysiology of heparin-induced thrombocytopenia type II and the development of direct thrombin inhibitors have improved the management of these patients, especially in the perioperative period.

Summary The lack of clinical methods for predicting which type of patients with thrombocytopenia are at risk of bleeding and the effectiveness of various platelet preparations call for research initiatives to provide better guidelines for transfusion practice. Controlled clinical trials are required to evaluate strategies for the prophylactic use of platelets and thrombopoietic factors in idiopathic thrombocytopenic purpura and the use of direct thrombin inhibitors in patients with heparin-induced thrombocytopenia.

Department of Anaesthetics, University of Sydney, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia

Correspondence to Peter C.A. Kam, Nuffield Professor of Anaesthetics, University of Sydney, Department of Anaesthetics, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia Tel: +61 2 9515 8507; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.