Refractory Immune Thrombocytopenia-A Rare Presentation, Advances & Therapeutic Challenges

Abstract

     

Primary ITP has multiple treatment approaches which were proved clinically includes TPO receptor agonists such as ROMIPLOSTIM,ELTROMBOPAG & RITUXIMAB)  & FOSTAMTINIB &  SPLEENECTOMY. However, few patients with ITP not responding to more than 2 lines of treatment with severe & prolonged thrombocytopenia.considered as refractory immune thrombocytopenia . Diagnosis cannot be done through single test , it has to be done by multiple tests and by exclusion and based on response to the treatment.However it significantly increases the risks of bleeding , drug related toxicity & other life threatening complications .Though there are many advancements in the treatment of ITP ;So always managing a case of refractory ITP is a challenge. so ,in this we are commenting about the available treatment options , new therapeutic approaches and combinations strategies and their efficacy. The novel point of this article is it tells about all the available advanced treatment options and help in stepwise approach and to select appropriate treatment options at any particular given time.Particularly, combination strategies may target multiple pathogenic mechanisms and 2 ends of the same pathogenic mechanism which trigger synergistic effects .A series of events which arise from studies which are published & real life clinical experience also included which help to optimise management of refractory ITP.