Immune thrombocytopenic purpura: A rare case of postoperative thrombocytopenia

Abstract

A case of Immune Thrombocytopenic Purpura (ITP) presented as an unusual case of post- operative hemorrhage. Our patient had presented for an elective laparoscopic total extraperitoneal repair for an inguinal hernia. He had undergone the procedure with no procedural or immediate post- operative complications. On post- op day 1, our patient had developed tachycardia with hypotension with clinical examination revealing signs of pallor with petechiae and ecchymosis. A complete blood count revealed thrombocytopenia with normocytic anemia while coagulation parameters were normal. Serum biochemistries did not reveal any renal failure or elevated lactate dehydrogenase. A computer- tomography with angiography revealed features supportive of a hemoperitoneum. Our patient was first stabilized with transfusion and vasopressor support. Evaluation with bone marrow analysis revealed features suggestive of ITP while secondary workup remained negative. Our patient was managed with dexamethasone pulse followed by maintenance steroids, following which there was an incremental response of the platelet count.