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Bleeding and Infection-Reply

C. Thomas Kisker, MD
Am J Dis Child. 1973;125(6):900. doi:10.1001/archpedi.1973.04160060096024.
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Dr. Fernbach suggests that some transient benefit may occur as a result of platelet transfusion in an emergency bleeding episode in a patient with immunothrombocytopenia. There is, however, no controlled clinical evidence to support this. I would therefore strongly disagree that platelet transfusion should be used in preference to splenectomy in a patient with immunothrombocytopenia, and have witnessed the death of one child with thrombocytopenia associated with chickenpox in whom this therapeutic approach was attempted. When one considers that there is a greater than 70% probability of a prompt, significant, and permanent response to splenectomy in children with idiopathic thrombocytopenia,1 splenectomy would seem to be the treatment of choice in the unusual child with immunothrombocytopenia and a severe bleeding episode. With modern surgical techniques and supportive measures, splenectomy should not be considered as an overly hazardous procedure, but rather the procedure that offers the best possibility for survival in


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