A few words on management:
Steroids: first line. typically Prednisone 1mg/kg daily until the platelet count starts to rise, then taper. There are ongoing trials looking at shorter courses of high dose Dexamethasone now.
Intravenous Immunoglubulin: IVIG is frequently used after patients fail steroids. There is no clear time frame that dictates when IVIG should be used....some will initiate it after 4-5 days if there is no response to steroids, others may wait a bit longer.
Splenectomy: very effective for refractory ITP, but a bit invasive.
Rituximab: a very cool drug. It is a monoclonal antibody that binds to cells expressing CD-20 (B cells) and seems to be a promising alternative to splenectomy. Large trials are in the works.
Others: some other drugs that have been used successfully include vincristine, cyclophosphamide, and danazol.
Pimping 101: Accessory Spleen? What? Sometimes after splenectomy patients may still have resistant ITP. What's going on? Rarely a bit of splenic tissue is left behind, but even more rarely there may be an anatomic variant where there is a 'mini spleen' in the neighbourhood of the 'real spleen', about the size of a peanut M&M (See picture below).
Have a great day,
