AbstractThe effects of splenectomy in 49 thrombocytopenic patients managed since 1979 were assessed and compared with our previous experience of 174 patients. Idiopathic thrombocytopenic purpura (ITP) constitutes a common indication for splenectomy, which effects a cure in 86% of these patients. The platelet count rises above 100,000/mm3 by the eighth postoperative day in 88% of responders. Urgent splenectomy is indicated for patients with thrombotic thrombocytopenic purpura (TTP) because it is associated with the highest cure rate. Splenectomy in patients with myeloproliferative disorders causing thrombocytopenia effectively raises the platelet count but has been followed by the greatest incidence of complications among the hematologic disorders studied. In patients with chronic lymphatic or hairy cell leukemia, splenectomy almost always returns platelet counts to normal levels and there is an impressive improvement in the quality of life. A wide variety of disorders characterized by thrombocytopenia is responsive to splenectomy. Accessory spleens have been removed in 17% of ITP patients and are often present in patients with myeloproliferative disease, but only rarely noted in other patients with thrombocytopenia.