Thanks for the query at DoctorSpring.
I understand that your husband has been suffering from low platelet count (thrombocytopenia) due to possible ITP.
In regard to your question, the normal platelet count ranges from 150000 to 450000 /ul.
If the level falls 100000/ul it is termed as thrombocytopenia. However levels than 50000/ul causes posttraumatic bleeding and less than 20000/ ul causes spontaneous bleeding, fundal and intracranial bleeding. So with his present level less than 30000, there are risks of bleeding even following a minor trauma. Luckily the bleed he had in calf is not very harmful, but that might not be the case every time. For example a bleeding in the brain can be catastrophic.
So should we rush into splenectomy and the bone marrow test? – You should go for the bone marrow test as soon as possible. This is to rule out any other condition that may cause low platelets and will help in forming a final diagnosis of ITP. You need not ‘rush’ into splenectomy, but it needs to be considered as your husband is not having persistent response with Prednisolone, IVIG or having a spontaneous remission. Ideally one can wait 4-6 weeks before splenectomy to see whether the counts return normal. But in your husband’s scenario, I would recommend to trust your Doctors judgement. With the limited information I also feel that splenectomy is the best way to move forward. Other second line options are not as effective as splenectomy. When done electively this is a safe procedure.
Splenectomy acts by removing the major site of platelet destruction and brings down the concentration of circulating antiplatelet antibodies. It is a safe procedure. Side effects like infections (OPSI), fever may occur in certain individuals, but they are manageable. Your Doctor will recommend some immunization prior to the procedure. IVIG can be used but provide only temporary effect. So it would be best to go for a long-term solution. The count should be near normal. At least should be above 50,000 to prevent chances of bleed.
Hope this helps.
Please feel free to ask followup questions via email itself.