To assess clinical efficacy of platelet transfusion before liver and spleen resection in preventing intraoperative and postoperative bleeding for hepatocellular carcinoma (HCC) patients complicated with cirrhotic portal hypertension.

Clinical data of 118 HCC patients complicated with cirrhotic portal hypertension who underwent combined liver and spleen resection in Beijing Ditan Hospital affiliated to Capital Medical University from January 2010 to January 2024 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 70 patients were male and 48 female, aged from 35 to 68 years, with a median age of 57 years. According to whether platelet transfusion was performed before surgery, all patients were divided into the platelet transfusion and non-platelet transfusion groups. According to preoperative platelet (Plt) count, the patients were divided into three stratified subgroups of Plt≤30×10⁹/L, 31-49×10⁹/L and ≥50×10⁹/L groups, respectively. The effect of platelet transfusion on intraoperative bleeding, postoperative abdominal drainage, hemoglobin loss, incidence of postoperative bleeding, length of hospital stay and other indexes was analyzed in different stratified subgroups, and its role in promoting postoperative platelet recovery was assessed. Two-group comparison was performed by t-test and Chi-square test.

Subgroup analysis showed that compared with non-platelet transfusion group, intraoperative blood loss, the total amount of abdominal drainage at postoperative 2 d and hemoglobin loss were significantly reduced and the length of hospital stay was significantly shortened (t=-3.596, -3.316, -4.000, 4.815; all P<0.05), and the incidence of postoperative bleeding was decreased in patients with Plt ≤30×10⁹/L (χ²=5.051, P<0.05). The differences were not statistically significant between the Plt 31-49×10⁹/L and ≥50×10⁹/L subgroups (both P<0.05). At postoperative 1 and 24 h, Plt in the platelet transfusion group was significantly higher than that in the non-platelet transfusion group (t=6.410, 8.583; both P<0.05), whereas no significant difference was noted in Plt at postoperative 48 h and 7 d between two groups (both P>0.05).

For HCC patients complicated with cirrhotic portal hypertension with preoperative Plt ≤30×10⁹/L, preoperative platelet transfusion can effectively stop bleeding. Routine platelet transfusion should be conducted before surgery. However, routine platelet transfusion is not recommended for patients with preoperative Plt >30×10⁹/L. Preoperative platelet transfusion exerts insignificant effect upon long-term Plt level.