In severe ITP unresponsive to steroids, which intervention may be considered?

In severe ITP unresponsive to steroids, which intervention may be considered?

• A. Platelet transfusion as first-line therapy for all.
• B. Splenectomy.
• C. Anticoagulation therapy.
• D. Most infections are treated with antibiotics only.

Answer: (B)

When severe ITP does not respond to steroids, removing the spleen is considered because the spleen is the main site where antibody-coated platelets are destroyed. Splenectomy can eliminate a major source of platelet destruction and antibody production, leading to a durable rise in platelet counts for many adults and often allowing remission without ongoing immunosuppression. Before the procedure, vaccines against pneumococcus, meningococcus, and Haemophilus influenzae are given, and the patient must understand the infection risks after surgery, since overwhelming postsplenectomy infection is a serious concern and protective precautions are essential. Platelet transfusions, while sometimes used in acute bleeds, are not effective as a long-term strategy in ITP because the autoantibodies quickly destroy the transfused platelets, providing only a temporary bump. Anticoagulation is inappropriate in a patient with significant thrombocytopenia due to the risk of further bleeding. The option about treating most infections with antibiotics alone does not address the underlying problem of platelet destruction in ITP and is not an intervention for this condition.

When severe ITP does not respond to steroids, removing the spleen is considered because the spleen is the main site where antibody-coated platelets are destroyed. Splenectomy can eliminate a major source of platelet destruction and antibody production, leading to a durable rise in platelet counts for many adults and often allowing remission without ongoing immunosuppression. Before the procedure, vaccines against pneumococcus, meningococcus, and Haemophilus influenzae are given, and the patient must understand the infection risks after surgery, since overwhelming postsplenectomy infection is a serious concern and protective precautions are essential.

Platelet transfusions, while sometimes used in acute bleeds, are not effective as a long-term strategy in ITP because the autoantibodies quickly destroy the transfused platelets, providing only a temporary bump. Anticoagulation is inappropriate in a patient with significant thrombocytopenia due to the risk of further bleeding. The option about treating most infections with antibiotics alone does not address the underlying problem of platelet destruction in ITP and is not an intervention for this condition.