DEAR DR. DONOHUE: Five months ago, a relative started developing massive bruises all over her body. She went to the emergency room, where it was found that her platelet count was below 10,000. After several tests, they came up with a diagnosis of ITP (idiopathic thrombocytopenic purpura). She was put on cortisone, and her platelet count rose. When she was weaned off her cortisone, the count dropped again. Removal of her spleen is being suggested. Should she risk having her spleen removed without assurance of success? – S.V.

ANSWER: Platelets are essential for clot formation. When their numbers are too low, the threat of hemorrhage from minor trauma exists, so the condition often constitutes an emergency.

ITP is believed to result from an immune system that covers platelets with antibodies. Such coated platelets are consumed by the spleen, and that accounts for the drop in their numbers.

Cortisone drugs harness antibody production, and platelet numbers rise. Prednisone is the one most often chosen. However, as many patients as half experience another platelet drop when cortisone is tapered off.

Removing the spleen restores the platelet population in 70 percent of patients. The odds, therefore, are in your relative’s favor for a successful outcome, and the suggestion for splenectomy is on sound ground.

If splenectomy is not possible, or if it is refused, then medicines such as azathioprine or cyclophosphamide can be tried. A brand-new drug is Rituxan.

When the platelet count is low – in the 20,000 to 30,000 range – and there are no hints that bleeding is taking place, some doctors observe their patients while waiting for a spontaneous remission. ITP in children takes a different course. Childhood ITP usually follows a viral infection, and 90 percent of children recover completely, often in a matter of months. Adult ITP follows a more prolonged and chronic path.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible.

Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.