What is ITP? Thrombocytopenia is the medical term for a low platelet count. Idiopathic means unknown cause. Purpura refers to the pin-prick bleeding under the surface of the skin that is a symptom of the low platelet count. In ITP, antibodies coat the surfaces of the platelets, destroying them and causing their level to drop. Removal of the spleen (splenectomy) The spleen sits under the rib cage on the left side of the abdomen. One of its functions is to remove old red blood cells. In most patients with ITP, it is the main site of platelet destruction. In chronic ITP, surgery to remove the spleen is an option if the platelet count remains too low or doesn't respond to treatment. Only about 10 per cent of children with acute ITP have the operation. Removing the spleen is a major operation and usually requires 7 to 10 days in hospital, although some surgeons are now able to remove the spleen using keyhole surgery. About two thirds of patients respond to splenectomy, but some of these eventually relapse. Splenectomy is not generally considered in the early phases of ITP, in pregnancy or in children under six. The spleen also removes bacteria from the bloodstream that are capable of causing serious infections. After a splenectomy, you will be vulnerable to infection by these organisms and so will be vaccinated against them. You will also have to take a lifelong antibiotic such as penicillin.You should also carry a 'medic alert' card or bracelet.