<prompt> A patient with ITP has a platelet count of 50000 and is being planned for splenectomy. 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>: During surgery and in an emergency, fresh blood transfusions or platelet transfusions are required. Sometimes the anti-platelet immune response is temporarily blocked by IgG 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 cumm. The laparoscopic approach is ideal in elective splenectomy for ITP. Treatment for ITP - Methylprednisolone IV for 3-5 days only Oral prednisolone tablets--drug of choice for 6-12 weeks IV immunoglobulin 0.4-1.0 gkgday for 5 days only. It competes with antibodies Vincristine 2 mgweek for 6 weeks Danazol 200 mg tid Anti-Rh D antibodies Azathioprine Splenectomy FFP, platelet concentrate, fresh blood transfusions. ref: SRB;S manual of surgery, ed 3, pg no 608 