Esplenectomía laparoscópica en paciente con síndrome de Evans / Laparoscopic splenectomy in patient with Evans syndrome

RESUMEN

Resumen: El síndrome de Evans es una entidad rara que se presenta aproximadamente en 3.6 por cada millón de habitantes; siendo más común en el sexo femenino. Éste se caracteriza por la presencia de anemia hemolítica autoinmunitaria idiopática y púrpura trombocitopénica idiopática. Se presenta el caso de paciente femenino de 42 años de edad sin mejora en su nivel de plaquetas, por lo que se decide realizar esplenectomía mediante laparoscopía. La paciente, previo a la intervención quirúrgica, presenta nivel de plaquetas consideradas límites, 53,000/μL, por lo que se decide transfundir plaquetas previo al procedimiento. Durante la evaluación preanestésica se consignaron múltiples factores de riesgo para considerar una vía aérea difícil. Se optimizó el nivel de plaquetas y se mantuvieron esteroides perioperatorios. Se decidió dar anestesia general endotraqueal, con resultados satisfactorios durante el procedimiento quirúrgico.

ABSTRACT

Abstract: Evans syndrome is a rare syndrome that occurs in approximately 3.6 per million inhabitants; being more common in women. Its characteristics are the presence of idiopathic autoimmune hemolytic anemia and idiopathic thrombocytopenic purpura. We present a case of a 42-year-old patient with no improvement in her platelet level, so it was programmed to perform a laparoscopic splenectomy. The patient before the surgical intervention presented a level of platelets considered limit, 53,000/μL, so it was decided to transfuse platelets before surgery. During the pre-anesthesia evaluation, multiple risk factors were recorded to be considered as a difficult airways. Thrombocytopenia was improved and perioperative steroids were maintained. It was decided to administer general endotracheal anesthesia, obtaining satisfactory anesthesia during the surgical procedure.