Zacharia George, Walczyszyn Bartosz, Smith Kolton, Stoffels Guillaume, Spaccavento Colette, Levine Randy
Lenox Hill Hospital, New York, NY, USA.
Lenox Hill Hospital, New York, NY, USA.
Hematol Transfus Cell Ther. 2024 Nov;46 Suppl 5(Suppl 5):S3-S7. doi: 10.1016/j.htct.2023.06.005. Epub 2023 Jul 31.
A reduced platelet count (PLT) is a frequent post-operative finding in orthopedic surgery patients. Despite its prevalence, the characteristics of post-surgical thrombocytopenia have not been well described.
A retrospective chart review was conducted on patients who underwent a knee or hip replacement from 2012 to 2015. Patients who received heparin were excluded.
A total of 56 patients were analyzed on post-operative days 0 to 4. By day 1, 90.9% of the patients experienced a reduction in their platelet counts. The lowest mean platelet count (nadir) occurred on day 2 (201.3 × 10/L). The average decrease in the platelet count from the baseline was 24% (95%CI: 20.6 - 27.2). The change in the platelet count from the baseline ranged from a 49.6% drop to a 14.2% increase. A substantial portion of patients experienced thrombocytopenia, with 28% occurring on day 2. Platelet counts less than 100 × 10/L occurred only once. The percent decrease in the platelet count from the baseline to any other time point was significantly larger in patients aged > 65 years, compared to patients aged ≤ 65 years (p = 0.007). Specifically, the average drop in the platelet count at the nadir (day 2) relative to the baseline was 27.8% in patients aged > 65 years, compared to 19.5% in patients aged ≤ 65 years.
A reduction in the platelet count is a frequent post-operative finding in orthopedic surgery patients, even after removing confounding factors, such as heparin exposure, but clinical thrombocytopenia is uncommon. Alternative etiologies should be considered when the platelet count is less than 100 × 10/L. Vigilance should also be considered regarding elderly patients.
血小板计数（PLT）降低是骨科手术患者术后常见的表现。尽管其很常见，但术后血小板减少症的特征尚未得到充分描述。
对2012年至2015年接受膝关节或髋关节置换术的患者进行回顾性病历审查。排除接受肝素治疗的患者。
共对56例患者术后0至4天的情况进行了分析。到第1天，90.9%的患者血小板计数下降。最低平均血小板计数（最低点）出现在第2天（201.3×10⁹/L）。血小板计数相对于基线的平均下降幅度为24%（95%置信区间：20.6 - 27.2）。血小板计数相对于基线的变化范围从下降49.6%到上升14.2%。相当一部分患者出现血小板减少症，其中28%出现在第2天。血小板计数低于100×10⁹/L仅出现过一次。与年龄≤65岁的患者相比，年龄>65岁的患者从基线到任何其他时间点血小板计数的下降百分比显著更大（p = 0.007）。具体而言，年龄>65岁的患者在最低点（第2天）相对于基线的血小板计数平均下降27.8%，而年龄≤65岁的患者为19.5%。
即使排除诸如肝素暴露等混杂因素，血小板计数降低仍是骨科手术患者术后常见的表现，但临床血小板减少症并不常见。当血小板计数低于100×10⁹/L时，应考虑其他病因。对于老年患者也应保持警惕。
