Table 6.

An adult with symptomatic ITP who has failed to achieve a durable response with corticosteroids and IVIg

Management choice	Responses	Years in practice
		<5	5–20	>20
Anti-D (Win-Rho)	6	1	3	2
Corticosteroids (intermittent high dose dexamethasone)	0	0	0	0
IVIg	0	0	0	0
Observation with no drug treatment (“watchful waiting”)	0	0	0	0
Rituximab††	30	11	12	7
Splenectomy*	32	8	8	16
Thrombopoietin Receptor Agonists (Nplate [romiplostim], Promacta [eltrombopag])†	13	4	7	2
Other (describe): __________________	1**	0	0	1

^**Other response: “I offer both splenectomy and a TPO agent and discuss the options with the patient”.

Survey question 3. An active healthy, non-pregnant 28 year-old woman initially presented with a platelet count of 9,000/μl which increased to 170,000/μl with corticosteroid treatment, which was then tapered and discontinued. When corticosteroid treatment was stopped 3 months later epistaxis and mucosal bleeding developed associated with a platelet count of 9,000/μl. She was treated with corticosteroids and IVIg. She is uncomfortable with the side effects of corticosteroids. Although IVIg was effective for short times, it failed to maintain her platelet count at a level that controlled bleeding. Her complete blood count and smear review are otherwise normal, and her blood group is A+. What is your management choice?

^†Management recommended by the ICR: Grade A⁸

^††Management recommended by the ICR: Grade B⁸

^*Management recommended by ASH guideline: Grade 1B⁹