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Thrombocytopenia Due to Splenic Sequestration

by David J. Kuter, MD, DPhil

Increased splenic platelet sequestration can occur in various disorders that cause splenomegaly. Although the thrombocytopenia in advanced cirrhosis is mostly due to reduced thrombopoietin production by the liver (and consequent reduced platelet production), platelets are sequestered in other forms of congestive splenomegaly.

The platelet count usually is >30,000/μL unless the disorder causing splenomegaly also impairs platelet production (eg, in myelofibrosis with myeloid metaplasia). Sequestered platelets are released from the spleen at times of stress. Therefore, thrombocytopenia caused only by splenic sequestration rarely causes bleeding. In patients with normal hepatic function, splenectomy corrects the thrombocytopenia; but splenectomy is not indicated unless severe thrombocytopenia due to simultaneous bone marrow failure is present.

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