Abstract: Background: Idiopathic thrombocytopenic purpura (ITP) is an acquired disorder in which there is immune-mediated destruction of platelets. ITP is characterized by mucocutaneous bleeding and a low, often very low platelet count with an otherwise normal peripheral blood cells and smear. Patients usually present either with ecchymoses and petechiae or with thrombocytopenia incidentally found on a routine complete blood count (CBC). Mucocutaneous bleeding, such as oral mucosal, gastrointestinal, or heavy menstrual bleeding may be present. Rarely, life threatening including central nervous system bleeding can occur. Splenectomy was initially described as a therapeutic measure for idiopathic thrombocytopenic purpura (ITP) by Kaznelson in 1916.1 This procedure remained the only effective treatment for ITP until 1951, when Harrington and colleagues2 discovered the role of plasma immunoglobulin in the induction of thrombocytopenia in ITP. Dameshek et al.3 coined the term hypersplenism and demonstrated a rise in platelet counts with the administration of steroids. Since then, medical management has been the primary treatment for ITP. Today, splenectomy is indicated in (1) refractory symptomatic thrombocytopenia after 4 to 6 weeks of medical therapy, (2) when toxic doses of steroids are required to achieve remission, and (3) for relapse of thrombocytopenia after an initial response to steroid therapy.