Navigating Refractory ITP: Clinical Insights and Treatment Strategies

EP: 1.Understanding Immune Thrombocytopenia: Pathophysiology, Classification, and Differentiation

EP: 2.Diagnostic and Patient Education Strategies in ITP

EP: 3.Managing Bleeding Risk in Patients with ITP

EP: 4.Living with ITP: Impact of Fatigue and Other Symptoms on Patients’ Quality of Life

EP: 5.Tailoring Care in ITP Through a Health Equity Lens

EP: 6.Looking Ahead in ITP: Addressing Unmet Needs and Embracing Innovation

EP: 7.Key Clinical Signs and Symptoms Used in Diagnosis of Immune Thrombocytopenia

EP: 8.Clinical Decision-Making in ITP: Timing Treatment Initiation and Therapy Goals

EP: 9.Current Treatment Algorithm for Management of Immune Thrombocytopenia

EP: 10.Addressing the Limitations of Current ITP Therapies

EP: 11.Risks versus Benefits: ITP Treatment Side Effects and the Influence on Patients’ Quality of Life

EP: 12.Defining Treatment Success, Failure, and When to Reassess Patients’ Management of ITP

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EP: 13.Navigating Refractory ITP: Clinical Insights and Treatment Strategies

EP: 14.Potential Impact of Emerging Therapies on Patients Living with ITP

For patients with very refractory ITP, treatment options have expanded significantly over the years. However, the first step is to confirm the diagnosis — ensuring that it truly is ITP and not another condition causing the low platelet count. This might involve ruling out other factors like drug interactions or considering a bone marrow biopsy, especially in older individuals whose platelet counts are not improving.

In cases of refractory ITP, combining therapies with different mechanisms can be effective. For example, using a TPO receptor agonist to boost platelet production alongside fostamatinib, which targets platelet destruction, may work synergistically to improve platelet counts. Exploring such combinations can provide additional benefit for patients who don’t respond well to single agents.

Historically, splenectomy has been a treatment option for refractory ITP, offering the potential for sustained long-term response. Before surgery, patients are vaccinated against encapsulated bacteria and may require antibiotics depending on their immune status. The procedure can be done laparoscopically or, rarely, via open surgery. Advances in surgical techniques have improved the success rates and safety of splenectomy in recent years.