As hepatic sequestration of platelets in ITP patients is correlated with refractoriness to splenectomy54, 55, our findings that the hepatocyte AMR plays a significant role in the clearance of anti-GPIbα-opsonized desialylated platelets provide a potential explanation for refractoriness to splenectomy, as well as to steroid and IVIG therapies. The gene discussed is GP1BA; the disease is autoimmune thrombocytopenic purpura.