When a thrombocytopenic patient has to undergo a major surgery, how should the doctor develop a treatment plan in the face of such a high risk? The patient was admitted to the hospital with a complaint of “irregular vaginal bleeding after menopause for 2 years, aggravated for 10 days”, with a regular menstrual cycle and long periods. She was treated with platelet transfusions at several local hospitals without improvement, and was recommended to be transferred to a local hospital. The patient had irregular vaginal bleeding again 10 days ago, with low volume, light red color, no abdominal pain and bloating, no dizziness, fatigue, panic and fever. She came to our hospital for further consultation and treatment. Ultrasound showed that the endometrium was thickened by about 7 mm, and she was admitted to our hospital with “postmenopausal vaginal bleeding investigation”. In 2008, the patient had undergone bone marrow aspiration in our hospital for thrombocytopenia, but no significant abnormality was found. Later, she had repeated blood tests in local hospitals, and her platelets were below normal values. Two years ago, she was diagnosed and treated as immune thrombocytopenia in our hospital. Gynecological examination: vulva: normal development, married type; vagina: patent, smooth mucosa, no obvious abnormal discharge; cervix: normal size, smooth, no contact bleeding and abnormal discharge; uterus: hard, normal size, movable, no pressure pain; adnexa: both sides were palpable with obvious abnormalities. The patient was admitted to the hospital to improve the relevant examination, physical examination: height 158cm, weight 90kg, blood pressure: 139/69mmHg, blood glucose 14.5mmol. Hysteroscopic pathology showed: (uterus) endometrial adenocarcinoma was considered, and the diagnosis was: “1. endometrial cancer 2. hypertensive disease 3. diabetes mellitus 4 immune platelet Decreased”. According to the patient’s clinical manifestations and pathological findings, the treatment options were surgery or radiotherapy, etc. However, the patient’s thrombocytopenia, which was 2*10^9/L at the lowest, was a contraindication to radiotherapy. After communication with the family, the family requested surgical treatment. However, surgery and anesthesia were very risky, and the patient had high-risk factors such as whole blood cytopenia, low platelets, hypertension, diabetes mellitus, etc. There was a possibility of excessive bleeding and bleeding more than once during and after surgery, and in severe cases, hemorrhagic shock and other serious threats to the patient’s life. After consultation with multiple departments such as hematology, cardiology, endocrinology and anesthesiology, the patient was treated actively to control blood sugar and blood pressure and to raise white blood cells and platelets, and a therapeutic amount of platelets was transfused before the operation, platelets and blood were prepared before the operation, and the operation was carried out with caution. Due to the patient’s low platelet count and obesity, minimally invasive surgery was chosen to reduce the risk of incisional bleeding and infection. According to the needs of the condition, “laparoscopic total hysterectomy + double adnexal resection + pelvic lymph node dissection + abdominal para-aortic lymph node dissection + intestinal adhesion release” was performed. The operation went smoothly, and postoperative treatment was given to stop bleeding and lower pressure, and anti-inflammatory and symptomatic support. The patient recovered well after the operation and was discharged one week after the operation with all vital signs stable. Patients with thrombocytopenia may have life-threatening conditions such as hemorrhage, difficult to stop bleeding, DIC, and hemorrhagic shock during major surgery. When the treatment plan requires major surgery and the option is only to show the surgery, it is possible to control the risk within a certain range through a meticulous treatment plan. Patients with low platelets can opt for minimally invasive laparoscopic surgery after aggressive preoperative preparation. (Liping Han, Qinghong Hu)