Perioperative management of severe immune thrombocytopenia in a patient with acute appendicitis- a case report

Presently, there is paucity of medical evidence that provides guidance on perioperative management of severe immune thrombocytopenia (ITP) in septic patients requiring emergency surgery. We present a case of a 61-year-old female with acute appendicitis who developed severe ITP and required emergency laparoscopic appendectomy. Through our case report, we propose that that an optimal platelet count for surgery can be achieved in patients with severe ITP using a combination of platelet transfusions, intravenous corticosteroids and intravenous immunoglobulins to facilitate emergency surgery. A multidisciplinary team approach is required in the perioperative and post operative management of these patients to expedite treatment and minimize and delays to emergency surgery. • Acute severe immune thrombocytopenia (ITP) in the setting of sepsis in patients awaiting emergency surgery presents a challenge for surgeons. • Optimal levels of platelets necessary for emergency surgery can be achieved using a combination of corticosteroids, intravenous immunoglobulins and platelet transfusions. • Perioperative diagnosis and management of severe ITP in surgical patients requires coordinated care between surgeons, haematologists and anaesthetists.