Anesthetic Management During Splenectomy for Severe Platelet Sequestration in a Human Immunodeficiency Virus (HIV)-Positive Patient: A Case Report.

Patients with compromised immune systems, particularly those living with human immunodeficiency virus (HIV) infection and HIV-related lymphoma, pose multiple challenges for anesthesiologists because of hematologic abnormalities, critically low platelet counts, and potential drug-drug interactions. This report describes a 55-year-old male patient with HIV and Burkitt-type non-Hodgkin lymphoma (NHL) who presented with splenomegaly and severe platelet sequestration. Preoperative hematologic optimization was achieved with two platelet apheresis sessions and tranexamic acid for antifibrinolytic prophylaxis. The patient underwent an elective splenectomy under balanced general anesthesia. Propofol, fentanyl, and rocuronium were used for anesthetic induction, and tracheal intubation was successfully performed using videolaryngoscopy without complications. Following surgery, transversus abdominis plane (TAP) blocks and rectus sheath blocks were performed using ropivacaine, providing adequate analgesia without the need for postoperative opioids. The patient remained hemodynamically stable throughout the procedure, with an uneventful anesthetic recovery and no bleeding or infectious complications. He was discharged on postoperative day 3, with a platelet count of 80,000/µL. Optimal perioperative management of HIV-positive patients with severe thrombocytopenia is essential for safe anesthetic care. Appropriate blood product utilization and regional analgesia techniques may further improve outcomes. Multidisciplinary management is crucial for minimizing perioperative risks and enhancing patient outcomes.