Onyalai is an acquired immune thrombocytopenia with 10% mortality. Conservative measures such as traditional medicines, corticosteroids and blood transfusion have not always controlled severe bleeding or prevented death. Five patients (2 male, 3 female) with onyalai who had uncontrollable haemorrhage, thrombocytopenia and documented previous attacks of severe bleeding, underwent splenectomy. The patients were screened for malaria, sickle-cell anaemia and bilharzia. Vitamin K and epsilon-aminocaproic acid were administered pre-operatively, and fresh blood was given during surgery. The duration of follow-up varied between 280 and 544 days. There were no operative complications. Bleeding stopped in all patients and the platelet counts increased within 24 hours. All achieved normal platelet counts, but these were not always sustained. Three patients remained free of disease with normal platelet counts up to days 539, 539 and 544 of follow-up. Two patients had a recurrence of bleeding and died from cerebral haemorrhage and haemorrhagic shock.