PB1278 - Thrombocytopenia in cardiovascular disease, surgery, and its implications Instituto Nacional de Pediatria, Mexico city , Mexico

Background: Thrombocytopenia in cyanotic heart disease patients, although well known, is not adequately understood. The presence of thrombocytopenia per se poses a dilemma for performing any surgery. Reports of hypoxia-induced thrombocytopenia have occurred in cases of severe and chronic hypoxia.
The report is to document the fact that patients with Cyanotic Congenital Heart Disease (CCHD) and severe thrombocytopenia related to the CHD need not be denied corrective surgery.

Aims: recognized thrombocytopenia secondary cardiac disease in a pediatric patient

Methods: We present a 1‑year‑old boy with double outlet right ventricle and ventricular septal defect and recurrent cyanotic spells was found to have severe thrombocytopenia with platelet counts in the range of 3–50,000/mm3. His thrombocytopenia improved following reoxygenation after the Lecompte surgery.
He was diagnosed with immune thrombocytopenia at first, and treated with steroids without response. We started to address the etiology, antiplatelet antibodies, and platelet-associated immunoglobulins were negative, the immunological approach was performed normally, smear blood and bone marrow were normal. Viral and bacterial examination results were insignificant. Hypoxia-induced thrombocytopenia was considered, which could only be diagnosed after the total correction of the hypoxia

Results: the surgery was performed with platelet transfusion and TEG follow-up, with no bleeding complications.
Figure 1 shows the platelet tendency

Conclusion(s): There are only a few reports of surgery in CCHD with severe thrombocytopenia as in this patient. Based on our findings, if a patient with CCHD presents with thrombocytopenia without an obvious cause, hypoxia-induced thrombocytopenia should be considered. Furthermore, in these cases, we may not need to be as concerned with postoperative bleeding because the thrombocytopenia will resolve itself after the corrective surgery. Perioperative hydration and platelet transfusion are helpful in the management of thrombocytopenia in CCHD patients, and the issue may not be as dangerous as is generally perceived. This may reduce the need for unnecessary preoperative management