Patients for elective splenectomy are usually referred to the surgeon by hematologists or oncologists, because their treatment with blood products, corticosteroids, plasmaphoresis, gamma globulins, or chemotherapy can no longer safely control the primary disease. Accordingly, the patient may require transfusion of blood products to raise the hematocrit or platelet counts to safe levels for general anesthesia and coagulation during surgery. Packed red cells may be given in advance of planned surgery, whereas platelets, with their short life span, may be infused just prior to and during the procedure. When platelet transfusions are contraindicated, endogenous platelet counts are often temporarily boosted with a few days of increased corticosteroid therapy, immune globulin or Rho D immune globulin (winrho) prior to surgery. If steroids are used, then they must be continued during and immediately after surgery. The patient should have a type and screening blood test, and blood products must be available for infusion. The size of the spleen should be determined by physical examination or imaging studies, as massive spleens are more safely approached by open splenectomy.