Question

A patient with ITP has a platelet count of 50,000 and is being planned for splenectomy. What is the best time for platelet infusion in this patient?

• A. 2 hours before surgery
• B. At the time of skin incision
• C. After ligating the splenic artery
• D. Immediately after removal of the spleen

Hint:

Give platelets only once the spleen can no longer destroy them, that is the moment its artery is tied off.

Answer 1

The Correct Option is C

Step 1: In immune thrombocytopenic purpura (ITP), antiplatelet antibodies coat platelets, and the spleen is the major organ that destroys these antibody-coated platelets and also produces the antibody.
Step 2: If platelets are transfused early, before the spleen is dealt with, the spleen rapidly sequesters and destroys the transfused platelets, so the benefit is lost.
Step 3: The splenic artery is the main inflow to the spleen. Ligating it cuts off blood flow so the spleen can no longer trap and destroy circulating platelets effectively.
Step 4: Therefore the ideal time to give platelets is after the splenic artery has been ligated. The transfused platelets then survive and help control intraoperative bleeding when they are most needed.
Step 5: Giving platelets 2 hours before surgery or at skin incision (options A and B) wastes them on the still-active spleen. Waiting until after the spleen is removed (option D) is later than needed; once the artery is tied the spleen is functionally out, so platelets given at that point are already protected and can act during the rest of the operation.
Answer: C. After ligating the splenic artery.