Q: I am 68 years old. My son-in-law is a doctor and he routinely checks my complete blood count. It revealed a very low level of platelet count of 33 tho/cu. I underwent a blood test, marrow biopsy and liver scan tests etc. They were all normal and within range. RBC and WBC were also normal. No myelodysplasia. I was put on Prednisone tablets for 6 weeks. Platelet counts will be monitored as long as I am on Prednisone. If there is no improvement then the hepatologist has advised spleen removal. He says that spleen surgery by laparoscopy is usually not done in India. Please advise.

A:The normal platelet count ranges from 150,000 - 400,000/ml and a reduction in platelets (thrombocytopenia) may be mild (100,000 - 150,000/ml), moderate (50,000 - 100,000/mlƒw) or severe (less than 50,000/ml). Idiopathic thrombocytopenic purpura (ITP) is the presence of isolated thrombocytopenia with a normal bone marrow and the absence of other causes to account for it. ITP is caused by increased peripheral platelet destruction, with most patients having antibodies to specific platelet membrane glycoproteins while relative marrow failure may contribute to this. These antibody coated platelets by are removed in the spleen. There are two distinct types - acute ITP in children which has an abrupt onset and chronic ITP in adults which is gradual in its appearance. Spontaneous remission occurs in more than 80% of cases in children but is uncommon in adults. No treatment is required when the platelet counts are more than 50,000/ml. Treatment is indicated - a) When platelets are less than this and there is significant mucous membrane bleeding b) In patients with hypertension, peptic ulcer disease or vigorous lifestyle who have a risk factor for bleeding c) When platelet count <20,000-30,000/ml Glucocorticoids and intra-venous gammaglobulins (I.V. Ig) are the mainstays of medical therapy. Their use and dose is dictated by the symptoms, patients clinical condition and the platelet count. Platelet transfusion is indicated for controlling severe hemorrhage. Splenectomy is reserved for patients in whom medical therapy fails. Long-term steroid use and splenectomy are associated with certain complications. Steroids may lead to osteoporosis, glaucoma, cataracts, loss of muscle mass, and an increased risk of infection while splenectomy can cause infection or sepsis. Laparoscopic splenectomy is readily available in most major hospitals in India and you can easily have this surgery done here.