<prompt> A patient with ITP has a plalelet count of 50,000 and is being planned for spleenectomy. What is the best time for platelet infusion in this patient2 hours before surgeryAt the time of skin incisionAfter ligating the splenic aeryImmediately after removal of spleen  <response>: .Indications for splenectomy: 1. Relapsed severe cases after treatment with steroids - for 6 weeks 2. Girls attaining menarche 3. ITP persisting even after 6-9 months refractory to treatment 4. In 2nd trimester pregnancy, with platelet count 10000mm3 and severe bleeding problems 5. Recurrence after stoppingtapering steroids 6. Profound GI bleed and intracranial bleed Surgery During surgery and in emergency, fresh blood transfusions or platelet transfusions are required. Sometimes anti-platelet immune response is temporarily blocked by Ig G transfusion so to allow the platelet count to rise at the time of surgery or in cases of severe bleeding or in pregnancy. Accessory spleen should be identified and removed. In 7 days platelet count raises to more than 100000 cu mm. Laparoscopic approach is ideal in elective splenectomy for ITP. ref : SRB;s manual of surgery,3 rd ed,pg no 607 