.Indications for splenectomy: 1. Relapsed severe cases after treatment with steroids - for 6 weeks 2. Girls attaining menarche 3. ITP persisting even after 6-9 months refractory to treatment 4. In 2nd trimester pregnancy, with platelet count <10000/mm3 and severe bleeding problems 5. Recurrence after stopping/tapering steroids 6. Profound GI bleed and intracranial bleed Surgery * During surgery and in emergency, fresh blood transfusions or platelet transfusions are required. Sometimes anti-platelet immune response is temporarily blocked by Ig G transfusion so to allow the platelet count to rise at the time of surgery or in cases of severe bleeding or in pregnancy. * Accessory spleen should be identified and removed. * In 7 days platelet count raises to more than 100000/ cu mm. * Laparoscopic approach is ideal in elective splenectomy for ITP. ref : SRB&;s manual of surgery,3 rd ed,pg no 607