ABSTRACT : Immune thrombocytopenia is an autoimmune dosorder characterised by immunologic destruction of platelets most commonly occurring in response to unknown stimulus.The incidence of immune thrombocytopenia ha been estimated to affect approximately 1 in 10,000 population and occurs most commonly in women in 2nd -3rd decade of life

METHODS : A 45 yr old female who presented with heavy menstrual cycles for past 10yrs was planned for hysterectomy . Investigations revealed pancytopenia in complete blood count. Peripheral blood showed macrocytic hypochromia with thrombocytopenia. Reticulocyte count was 1.2%.Pateint was non reactive for HIV, HBsag and HCV.DAT was negative.USG Abdomen and pelvis showed multiple fibroids in uterus.She was started on high dose dexamethasone for 4 days.Platelet and Packed cells transfused.

RESULTS : Subsequent platelet count were done and there was no further drop in platelets. Platelet count on previous day of surgery was 90,000.Hence subarachanoid block done with 26 gauge spinal needle. Perioperatively adequate hemostasisacheived. Postoperative period was uneventful.

CONCLUSIONS : Immune thrombocytopenia is condition posing risk of life threatening hemorrhage and major anesthetic and surgical challenge to achieve hemostasis. Hence good knowledge of the various modalities of treatment is required for safe perioperative outcome.

References 1)British committee for standards in Haematology Guidelines for investigations and management of ITP in adults, children and pregnancy. British Journal of Haematology 2003 ; 120:574-596 2)Brain -J Pollard, T Ainley . Blood: Idiopathic thrombocytopenic purpura.Handbook of clinical anesthesia , 2 nd edition p 210-211