Cardiac surgery in a patient with severe thrombocytopenia: how low is too low?

Platelets play a very important role in hemostasis, especially after cardiac surgery. Excessive bleeding after such surgery may lead to increased need for transfusion and its incumbent increase in post-operative morbidity and mortality. Although most cardiac surgeons will offer a surgical option to a patient with moderate thrombocytopenia (platelet count around 70 × 10 9 /L), successful cardiac surgery has not been reported in patients with significantly lower platelets counts (less than 40 × 10 9 /L). We report a case of severe thrombocytopenia (19 × 10 9 /L) where coronary artery bypass grafting was performed with minimal blood loss post-operatively, discuss the patient's management and provide insights while dealing with such patients.