Impact of severe thrombocytopenia on the safety of splenectomy in patients with cirrhosis predominantly caused by Wilson's disease

Objective Due to the risk of bleeding and other related complications, severe thrombocytopenia (PLT ≤ 30 × 10 9 /L) has been regarded as a relative contraindication for splenectomy in patients with liver cirrhosis. This study aimed to investigate the impact of severe thrombocytopenia on the safety of splenectomy in cirrhotic patients mainly caused by Wilson's disease. Methods Patients were divided into three groups according to preoperative platelet count: mild, moderate, and severe thrombocytopenia. Baseline characteristics, surgical variables, postoperative outcomes, complications, and dynamic perioperative platelet counts were collected for all patients. Statistical analysis was performed using SPSS 27.0 to compare the differences in clinical data among the three groups. Results No significant differences were observed among the three groups in baseline data, surgical indicators, mortality, gastric tube drainage volume, or total drainage volume ( P > 0.05). The severe thrombocytopenia group had a significantly higher abdominal drainage volume at 48 h postoperatively than the mild group ( P = 0.025), and a significantly higher incidence of postoperative portal vein thrombosis ( P = 0.008, P = 0.010). There were significant differences in the incidence of postoperative fever among the three groups ( P < 0.05), but no significant statistical difference was found between the severe group and the mild or moderate groups ( P > 0.05). On postoperative days 3 and 7, the amylase level in abdominal drainage fluid of the severe group was significantly lower than that of the mild group ( P = 0.005, P = 0.003). The postoperative platelet levels of all patients were significantly higher than the preoperative levels ( P < 0.05); on postoperative days 1 and 7, there were significant differences in platelet levels between the severe thrombocytopenia group and the mild group ( P < 0.05), but by postoperative day 7, the platelets of all three groups had recovered to the normal range. Conclusion In Child-Pugh A/B patients with cirrhosis predominantly caused by Wilson's disease and hypersplenism, severe preoperative thrombocytopenia is not an absolute contraindication to splenectomy. Liver functional reserve is critical for surgical safety. However, severe thrombocytopenia is associated with an increased risk of PVT, which necessitates intensified perioperative anticoagulation.