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February 1987

Splenectomy for Thrombocytopenia in Chronic Liver Disease

Author Affiliations

Joplin, Mo

Arch Intern Med. 1987;147(2):195. doi:10.1001/archinte.1987.00370020015006

To the Editor.  —Immune thrombocytopenia is not an indication for splenectomy. Immune thrombocytopenic purpura may be an indication for splenectomy,1 but a platelet count below 150 000/mm3 (150 × 109/L) is not. In immune thrombocytopenia, the patients usually do not have purpura unless the platelet count is below 20 000/mm3 (20×109/L). In the six patients reported by Skootsky et al,2 no platelet count was that low, the word purpura is not used in their descriptions, and there is no mention of unusual bleeding or need for platelet transfusion during splenectomy. The final sentence of their article is reason not to perform splenectomy without valid indication: "Asplenia predisposes patients to infection."