A Case of Idiopathic Thrombocytopenic Purpura Requiring Aneurysm Clipping Surgery with Pre-operative High-dose Gamma Globulin Therapy

Kota Kurisu; Masaaki Hokari; Katsuyuki Asaoka; Kazuki Uchida; Hiroshi Ikeda; Tatsuro Takada; Minoru Ajiki; Ayako Terashi; Taku Shimizu; Koji Itamoto

doi:10.2335/scs.51.62

January 1, 2023Surgery for Cerebral StrokeOpen Access

A Case of Idiopathic Thrombocytopenic Purpura Requiring Aneurysm Clipping Surgery with Pre-operative High-dose Gamma Globulin Therapy

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Key Points

To report the perioperative management of a patient with idiopathic thrombocytopenic purpura and a growing cerebral aneurysm undergoing craniotomy clipping using preoperative high-dose intravenous immunoglobulin.
Conducted a single-patient case evaluation of a 53-year-old male with untreated idiopathic thrombocytopenic purpura and an enlarging anterior communicating artery aneurysm.
Administered high-dose intravenous gamma globulin for five consecutive days starting six days before elective surgery due to a past anaphylactic reaction to platelet transfusions.
Platelet counts increased from 1.9 × 10^4/mm^3 on admission to 12.7 × 10^4/mm^3 two days prior to surgery, maintained above 10.0 × 10^4/mm^3 perioperatively, and settled at 5.5 × 10^4/mm^3 three weeks post-operation.
Craniotomy clipping proceeded as scheduled without any perioperative hemorrhagic complications.

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Implication

Case report demonstrates successful aneurysm clipping following high-dose gamma globulin in a patient with ITP, highlighting IVIG for perioperative bleeding risk control.

Abstract

特発性血小板減少性紫斑病（idiopathic thrombocytopenic purpura：ITP）合併患者の周術期出血リスクを軽減するために，血小板増加を促す治療を要することがある．今回われわれはITPを合併した未破裂脳動脈瘤患者の開頭クリッピング手術に際して，術前にγグロブリン大量静注（IgG）療法を行い，良好な転帰を得た1例を経験したので報告する．症例は53歳男性．3年前にITPと診断されたが無投薬で経過観察されていた．前交通動脈瘤は経過観察期間中の増大傾向を示し，今回開頭クリッピング手術を行うこととなった．過去に血小板輸血にてアナフィラキシー反応を起こした既往もあり，手術に際しては血小板数増加を促す目的に術前6日前から連続5日間のIgG療法を計画した．IgG療法にて血小板数は入院時1.9×104/mm3から手術2日前には12.7×104/mm3まで増加した．クリッピング手術は予定通りに行い，周術期に出血性合併症の出現なく良好に経過した．血小板数は，周術期10.0×104/mm3以上を維持し，術後3週間の時点では5.5×104/mm3まで低下していた．本症例のような，ITP合併症例の開頭手術に際して，術前IgG療法を行い周術期管理することは有用である．特に待機的に手術可能なITP合併例では，IgG療法を行うことを検討する必要がある．

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Cite This Study

Kurisu et al. (2023) studied this question.

synapsesocial.com/papers/6ab4cbf61f3d2b1178b0aeb6 https://doi.org/10.2335/scs.51.62

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A Case of Idiopathic Thrombocytopenic Purpura Requiring Aneurysm Clipping Surgery with Pre-operative High-dose Gamma Globulin Therapy

Key Points

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

A Case of Idiopathic Thrombocytopenic Purpura Requiring Aneurysm Clipping Surgery with Pre-operative High-dose Gamma Globulin Therapy

Key Points

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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