{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T15:21:43Z","timestamp":1787498503652,"version":"build-2736575974"},"reference-count":27,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T00:00:00Z","timestamp":1725580800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>We present the case of a 66 year-old male patient who developed severe postoperative thrombocytopenia after revision total hip arthroplasty. The patient underwent surgery in a dedicated orthopedics hospital and was initially managed in the intensive care unit. Upon the development of thrombocytopenia, he was referred to a dedicated hematology clinic for investigation and advanced management. A thorough diagnostic algorithm was employed in order to rule out the main causes of thrombocytopenia. By exclusion, we diagnosed the patient as suffering from a rare and severe form of postoperative thrombocytopenia through an immune mechanism. Although postoperative thrombocytopenia is relatively frequent but transitory and no treatment is required, this condition was refractory to corticosteroids and substitution therapy; however, it quickly responded to treatment with thrombopoietin receptor agonists. The patient recovered and was successfully discharged with normal platelet values. While rare occurrences, alternative causes of thrombocytopenia such as infection, drug-induced, or immune should be considered in patients developing postoperative thrombocytopenia.<\/jats:p>","DOI":"10.3390\/life14091124","type":"journal-article","created":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T05:02:28Z","timestamp":1725598948000},"page":"1124","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Postoperative Thrombocytopenia after Revision Arthroplasty: Features, Diagnostic and Therapeutic Considerations"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6213-0142","authenticated-orcid":false,"given":"Carmen","family":"Saguna","sequence":"first","affiliation":[{"name":"Hematology Clinic, Coltea Clinical Hospital, 030171 Bucharest, Romania"},{"name":"Department of Hematology, The \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicoleta Mariana","family":"Berbec","sequence":"additional","affiliation":[{"name":"Hematology Clinic, Coltea Clinical Hospital, 030171 Bucharest, Romania"},{"name":"Department of Hematology, The \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian","family":"Platon","sequence":"additional","affiliation":[{"name":"Hematology Clinic, Coltea Clinical Hospital, 030171 Bucharest, Romania"},{"name":"Department of Hematology, The \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Marcoci","sequence":"additional","affiliation":[{"name":"Hematology Clinic, Coltea Clinical Hospital, 030171 Bucharest, Romania"},{"name":"Department of Hematology, The \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea","family":"Jercan","sequence":"additional","affiliation":[{"name":"Department of Hematology, The \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Hematology Clinic, \u201cDr. Carol Davila\u201d Military Emergency Hospital, 010825 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrei","family":"Colita","sequence":"additional","affiliation":[{"name":"Hematology Clinic, Coltea Clinical Hospital, 030171 Bucharest, Romania"},{"name":"Department of Hematology, The \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2269-511X","authenticated-orcid":false,"given":"Mihai Emanuel","family":"Gherghe","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, \u201cFoisor\u201d Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana-Georgiana","family":"Nedelea","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, \u201cFoisor\u201d Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romica","family":"Cergan","sequence":"additional","affiliation":[{"name":"Department of Anatomy, The \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Radiology and Medical Imaging, \u201cFoisor\u201d Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7676-6393","authenticated-orcid":false,"given":"Cristian","family":"Scheau","sequence":"additional","affiliation":[{"name":"Department of Radiology and Medical Imaging, \u201cFoisor\u201d Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania"},{"name":"Department of Physiology, The \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7403-1684","authenticated-orcid":false,"given":"Serban","family":"Dragosloveanu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, \u201cFoisor\u201d Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania"},{"name":"Department of Orthopaedics and Traumatology, The \u201cCarol Davila\u201d University of Medicine and 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Educ. Program. Am. Soc. Hematol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Zachariah, G., Walczyszyn, B., Smith, K., Stoffels, G., Spaccavento, C., and Levine, R. (2023). Characteristics of the post-surgical decrease in platelet counts in orthopedic surgery patients, observations and insights. Hematol. Transfus. Cell Ther.","DOI":"10.1016\/j.htct.2023.06.005"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1182\/blood.V88.1.3.3","article-title":"Idiopathic thrombocytopenic purpura: A practice guideline developed by explicit methods for the American Society of Hematology","volume":"88","author":"George","year":"1996","journal-title":"Blood"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1159\/000205245","article-title":"Changes in the Platelet Levels of Non-transfused Patients Following Surgical Operations","volume":"17","author":"Mustard","year":"2009","journal-title":"Acta Haematol."},{"key":"ref_6","first-page":"e55263","article-title":"Etiology of Total Knee Arthroplasty Revisions: A Two-Decade Institutional Perspective","volume":"16","author":"Dragosloveanu","year":"2024","journal-title":"Cureus"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2805","DOI":"10.1007\/s00402-022-04453-x","article-title":"Can machine learning models predict failure of revision total hip arthroplasty?","volume":"143","author":"Klemt","year":"2023","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"216","DOI":"10.3892\/etm.2020.9346","article-title":"A new perspective towards failure of gamma nail systems","volume":"20","author":"Dragosloveanu","year":"2020","journal-title":"Exp. Ther. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/s10195-023-00719-1","article-title":"Managing early complications in total hip arthroplasty: The safety of immediate revision","volume":"24","author":"Descamps","year":"2023","journal-title":"J. Orthop. Traumatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1016\/j.joca.2008.02.009","article-title":"2007 OARSI recommendations for the management of hip and knee osteoarthritis: Towards consensus?","volume":"16","author":"McAlindon","year":"2008","journal-title":"Osteoarthr. Cartil."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Mornese Pinna, S., Corcione, S., Cavallone, E., Shbaklo, N., Vita, D., De Benedetto, I., Montrucchio, G., Pasero, D., Trompeo, A.C., and Costamagna, A. (2024). Epidemiology and Risk Factors for Nosocomial Infections in Left Ventricular Assist Device Recipients. Life, 14.","DOI":"10.3390\/life14020270"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Tsantes, A.G., Parastatidou, S., Tsantes, E.A., Bonova, E., Tsante, K.A., Mantzios, P.G., Vaiopoulos, A.G., Tsalas, S., Konstantinidi, A., and Houhoula, D. (2023). Sepsis-Induced Coagulopathy: An Update on Pathophysiology, Biomarkers, and Current Guidelines. Life, 13.","DOI":"10.3390\/life13020350"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"780","DOI":"10.2106\/00004623-200704000-00012","article-title":"Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030","volume":"89","author":"Kurtz","year":"2007","journal-title":"J. Bone Jt. Surg Am."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"168","DOI":"10.5507\/bp.2019.034","article-title":"Monitoring of fibrinolytic system activity with plasminogen, D-dimers and FDP in primary total knee arthroplasty (TKA) after topical, intravenous or combined administration of tranexamic acid","volume":"164","author":"Lostak","year":"2020","journal-title":"Biomed. Pap. Med. Fac. Univ. Palacky. Olomouc Czech Repub."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Singh, R., Gautam, P., Sharma, C., and Osmolovskiy, A. (2023). Fibrin and Fibrinolytic Enzyme Cascade in Thrombosis: Unravelling the Role. Life, 13.","DOI":"10.3390\/life13112196"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1053\/j.seminhematol.2022.02.005","article-title":"Platelet-activating anti-PF4 disorders: An overview","volume":"59","author":"Warkentin","year":"2022","journal-title":"Semin. Hematol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Warkentin, T.E. (2018). Thrombocytopenia caused by platelet destruction, hypersplenism, or hemodilution. Hematology, Elsevier.","DOI":"10.1016\/B978-0-323-35762-3.00132-3"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1182\/hematology.2023000503","article-title":"Thrombotic anti-PF4 immune disorders: HIT, VITT, and beyond","volume":"2023","author":"Greinacher","year":"2023","journal-title":"Hematol. Educ. Program. Am. Soc. Hematol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2305","DOI":"10.1182\/blood.2023022136","article-title":"Anti-PF4 immunothrombosis without proximate heparin or adenovirus vector vaccine exposure","volume":"142","author":"Esteban","year":"2023","journal-title":"Blood"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Favaloro, E.J., Pasalic, L., and Lippi, G. (2022). Antibodies against Platelet Factor 4 and Their Associated Pathologies: From HIT\/HITT to Spontaneous HIT-Like Syndrome, to COVID-19, to VITT\/TTS. Antibodies, 11.","DOI":"10.3390\/antib11010007"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1160\/TH16-06-0435","article-title":"Clinical picture of heparin-induced thrombocytopenia (HIT) and its differentiation from non-HIT thrombocytopenia","volume":"116","author":"Warkentin","year":"2016","journal-title":"Thromb. Haemost."},{"key":"ref_22","first-page":"247","article-title":"The effects of drugs used in anaesthesia on platelet membrane receptors and on platelet function","volume":"3","year":"2002","journal-title":"Curr. Drug Targets"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.curtheres.2005.08.010","article-title":"Effects of isoflurane, sevoflurane, and desflurane on platelet function: A prospective, randomized, single-blind, in vivo study","volume":"66","author":"Bozdogan","year":"2005","journal-title":"Curr. Ther. Res. Clin. Exp."},{"key":"ref_24","first-page":"497","article-title":"Locoregional anesthesia and coagulation","volume":"71","author":"Mentegazzi","year":"2005","journal-title":"Minerva Anestesiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/j.cll.2021.07.009","article-title":"Transfusion Reactions and Adverse Events","volume":"41","author":"Abdallah","year":"2021","journal-title":"Clin. Lab. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/S0002-9629(15)41648-9","article-title":"Review: Postoperative thrombocytopenia: With etiologic, diagnostic, and therapeutic consideration","volume":"311","author":"Chang","year":"1996","journal-title":"Am. J. Med. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.bja.2018.09.010","article-title":"Perioperative thrombocytopenia: Evidence, evaluation, and emerging therapies","volume":"122","author":"Nagrebetsky","year":"2019","journal-title":"Br. J. Anaesth."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/14\/9\/1124\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:49:41Z","timestamp":1760111381000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/14\/9\/1124"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,6]]},"references-count":27,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,9]]}},"alternative-id":["life14091124"],"URL":"https:\/\/doi.org\/10.3390\/life14091124","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,6]]}}}