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Dear Sir,
Hypersplenism is a cause of thrombocytopenia in hemodialyzed patients [1, 2]. In such cases splenomegaly and cytopenias are often present [3].
We present two hemodialyzed patients with `isolated' thrombocytopenia (normal platelet kinetics) caused by hypersplenism. Only splenectomy improved this alteration.
A 44-year-old man, on hemodialytic treatment for 9 years, presented with isolated and severe thrombocytopenia (fig. 1) and small splenomegaly. Platelet-function tests (ristocetin, ADP) showed no significant alterations. Bone marrow biopsy indicated normal bone structure and cellularity with an abundant megakaryocytic series in different phases of thrombocytopoiesis. Hepatosplenic scintigraphy with labelled platelets showed a typical hypersplenic picture with increased splenic volume. Study of labelled platelet kinetics with Iin showed a normal survival curve. The search for antiplatelet antibodies was weakly positive. Steroid treatment resulted in a partial and transitory increment in platelet count which was normalized only after splenectomy (fig. 1). Histologic examination of the spleen showed widening of the sinusoids, hyperplasia of the red pulp cords, numerous macrophages with emosiderin content, reduction of white pulp and increased plasma-cell component. Giant cells and cytoplasmic inclusions were not present.
A 52-year-old man, on regular dialytic treatment for...