DOI: https://doi.org/10.36347/sjmcr.2025.v13i11.031

Pages: 2799-2800

Severe thrombocytopenia poses a major anesthetic challenge due to high bleeding risk. We report an 81-year-old woman with myelodysplastic syndrome and refractory thrombocytopenia (<20,000/µL) requiring urgent iliac-to-mesenteric artery bypass for bowel ischemia. Despite transfusions, platelet counts remained low. General anesthesia with desflurane and remifentanil was maintained under strict hemodynamic and temperature control. Two apheresis platelet units were transfused, with an estimated blood loss of 200 mL. The surgery was completed uneventfully. This case demonstrates that major vascular surgery can be safely performed in patients with severe thrombocytopenia when individualized anesthetic planning, normothermia, and multidisciplinary communication are implemented.