Dr Crosby states that immune thrombocytopenia without purpura is not in itself an indication for splenectomy. In general we agree. Splenectomy may be indicated for immune thrombocytopenia with purpura or for other reasons.
In our article, two of six patients with chronic liver disease and persistent unexplained thrombocytopenia underwent splenectomy. Patient 1 had splenectomy not for thrombocytopenia per se, but as part of a diagnostic exploratory laparotomy for fever, sweats, and retroperitoneal lymphadenopathy. Patient 3 had upper gastrointestinal tract bleeding associated with moderately severe thrombocytopenia unresponsive to intense medical therapy. Laparotomy was performed to identify and control bleeding, and splenectomy was done because the thrombocytopenia was thought to be contributing to the ongoing bleeding. The bleeding site could not be identified; bleeding stopped after splenectomy and was associated with a rising platelet count. These observations indicate that in some patients with chronic liver disease-related thrombocytopenia, a minimally enlarged spleen may