A 43-year-old female with gastric cancer complicated by idiopathic thrombocytopenic purpura (ITP) showing hemorrhage preoperatively received some treatment for the improvement of anemia and high dose immunoglobulin therapy. The platelet count slightly increased from 0.8×10⁴/mm³to 4.2×10⁴/mm³ but was still inadequate for a complete surgery. Therefore, after platelet transfusion, total gastrectomy, D₂ lymph node dissection, and splenectomy for ITP were performed. The amount of hemorrhage during the surgery was 767g, but she was discharged from the hospital without postoperative complications. She is now being treated on an outpatient basis, but the platelet count is kept at about 3×10⁴/mm³, indicating no effects of splenectomy.
High dose immunoglobulin therapy for ITP is useful for temporarily increasing platelets. However, a minimum platelet count that allows surgery is not always obtained. Adjunctive methods such as platelet transfusion are necessary in addition to careful consideration of surgical methods.