Thromboelastography-guided recombinant factor VIIa administration in a patient with refractory autoimmune idiopathic thrombocytopenia.

Autoimmune idiopathic thrombocytopenia poses a significant challenge for clinicians in the perioperative period. Repeat platelet transfusions may not result in satisfactory increments in the platelet count and routine coagulation screens may not reflect the degree of abnormal hemostasis. We report the use of point-of-care testing with thromboelastography and platelet counting in managing a patient with refractory autoimmune idiopathic thrombocytopenia, undergoing a splenectomy for active bleeding. These tests were successfully used to monitor the frequency of administration of recombinant factor VIIa (NovoSeven(R), NovoNordisk, Copenhagen, Denmark) with platelet transfusions.