Immunoglobulin treatment before vascular surgery in patients with chronic idiopathic thrombocytopenia

The authors describe 2 patients with chronic idiopathic thrombocytopenic purpura (ITP) associated with atherosclerotic peripheral vascular disease demonstrated by Doppler examination and digital intravenous arteriography. Two weeks before surgical treatment, a daily venous infusion (for five days) of 400 mg/kg of immunoglobulin was performed. The platelet count at the beginning of treatment was 23,000/mm3 in the first patient and 25,000/mm3 in the second. Ten days later, the patients had a good response with a platelets increase of 151,000/mm3 and 162,000/mm3 respectively. Subsequently two aortobifemoral operations were required without surgical or ITP-related complications. At the follow-up the platelet count was 110,000/mm3 in the first patient (ten months) and 132,000/mm3 in the second (fourteen months). Their results suggest that an adequate preoperative preparation in patients with chronic ITP may lead to a good response without postoperative bleeding or other complications.