During Splenectomy in ITP, platelet is infusion given at
|A||Immediately after ligating splenic vein|
|B||Immediately after removal of spleen|
|D||Next day of surgery|
a. The usual first line of therapy is oral prednisone at a dose of 1.0 to 1.5 mg/kg per day.
b. Intravenous immunoglobulin is thought to impair clearance of IgG-coated platelets by competing for binding to tissue macrophage receptors. An immediate response is common, but a sustained remission is not.
c. Splenectomy is indicated for failure of medical therapy, for prolonged use of steroids with undesirable effects, or for most cases of first relapse.
d. Prolonged use of steroids can be defined in various ways, but a persistent need for more than 10 to 20 mg/d for 3 to 6 months in order to maintain a platelet count above 30,000/mm3 generally prompts referral for splenectomy.
e. Splenectomy provides a permanent response without subsequent need for steroids in 75 to 85% of the total number of patients undergoing splenectomy.
f. Responses usually occur within the first postoperative week. Patients with extremely low platelet counts (<10,000/mm3) should have platelets available for surgery, but should not receive them preoperatively. Once the splenic pedicle is ligated, platelets are given to those who continue to bleed