Idiopathic thrombocytopenic purpura: detection of accessory splenic tissue.

The presence of Howell-Jolly bodies in the peripheral blood smear does not rule out the possibility that small amounts of splenic tissue are present. The liver-spleen scintigram appears to be the most sensitive test at this time for the detection and localization of functional accessory splenic tissue. Three of seven patients with idiopathic thrombocytopenic purpura and splenectomy had no Howell-Jolly bodies before removal of an accessory spleen. Therefore, the performance of a routine blood smear as the only test appears to be of limited value. Our data and a review of the literature do not allow a definitive statement as to the effectiveness of accessory splenectomy in patients with recurrent idiopathic thrombocytopenic purpura and with accessory splenic tissue. However, until this is clarified, accessory splenectomy should be considered as a possible therapeutic modality.