Abstract
Chronic idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by low platelet counts due to increased destruction and impaired production. A 24-year-old male from Kashmir presented with bleeding gums, nosebleeds, petechiae, and oral ulcers. Initial evaluation revealed critical thrombocytopenia (platelets: 45,000/mm³) and positive antinuclear antibodies, consistent with ITP. Despite treatment with steroids, rituximab, and IVIg, his platelet count dropped to 1,000/mm³, necessitating laparoscopic splenectomy. A multidisciplinary approach ensured preoperative stability. The surgery, marked by controlled blood loss (350–250 mL), improved platelet counts postoperatively (75,000/mm³). This case underscores the challenges of splenectomy in severe ITP and the importance of comprehensive care.