When should platelets be transfused for a patient with ITP undergoing splenectomy?

Transfusing platelets at the time of incision for a patient with immune thrombocytopenic purpura (ITP) undergoing splenectomy is appropriate because it helps to ensure adequate hemostasis during the surgical procedure. In ITP, the patient's platelet count is typically low due to destruction of platelets by the immune system.

During splenectomy, the spleen, which plays a critical role in the destruction of platelets, is removed. While surgery can potentially lead to bleeding, providing platelets just at the time of incision ensures that the surgical team has the highest possible platelet count at the moment when they need it most, thereby minimizing the risk of bleeding complications during the operation. This approach aligns with the timing of transfusion needs in the perioperative period, emphasizing the importance of optimizing the patient's condition right before starting the surgery.

Transfusing platelets before surgery may not provide the same immediate benefit, as there is the potential for active bleeding or other factors to affect the availability of those infused platelets by the time the incision is made. Additionally, transfusing only if there is significant pre-operative bleeding does not proactively address the idiosyncratic risks associated with low platelet counts during surgical procedures. Therefore, the