How do you choose between therapies for newly diagnosed ITP that is refractory to steroids and IVIG?
Received dexamethasone 40 mg daily x4 and IVIG without response. No DIC. PB flow cytometry and bone marrow biopsy without pathology. Are there specific circumstances where you favor TPO mimetics, rituximab, or splenectomy?
Answer from: at Academic Institution
The important questions here are what are the symptoms and what are the platelet counts? In patients who fail to respond to either corticosteroids or IVIG, the concern is whether this is actually immune thrombocytopenia or another cause of thrombocytopenia. With "normal" flow and bone marrow results...