Increased splenic platelet sequestration can occur in various disorders that cause splenomegaly. However, thrombocytopenia that occurs in advanced cirrhosis is mostly due to reduced thrombopoietin production by the liver (and consequent reduced platelet production) rather than splenic sequestration (1). (See also Overview of Platelet Disorders.)
The platelet count usually is > 30,000/mcL 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; however, splenectomy is not indicated unless severe thrombocytopenia due to simultaneous bone marrow failure is present.
Peck-Radosavljevic M, Wichlas M, Zacherl J, et al: Thrombopoietin induces rapid resolution of thrombocytopenia after orthotopic liver transplantation through increased platelet production. Blood 95:795–801, 2009.