What is considered the last resort treatment for immune thrombocytopenic purpura (ITP)?

The last resort treatment for immune thrombocytopenic purpura (ITP) is spleen removal, also known as splenectomy. This procedure is considered when other treatments have failed and the patient continues to experience significant symptoms or risks associated with low platelet counts.

ITP occurs when the immune system mistakenly attacks and destroys platelets, leading to low platelet counts and increased bleeding risk. While corticosteroids and intravenous immunoglobulin (IVIG) are commonly used first-line treatments to increase platelet counts, they may not always be effective in the long term for all patients.

Platelet transfusions are generally not effective in ITP because the underlying problem involves the immune system's destruction of the platelets rather than a lack of production. Therefore, the transfused platelets would also be targeted and destroyed by the immune system.

Splenectomy removes the spleen, which plays a crucial role in the destruction of platelets in ITP. By removing the spleen, the immune system’s action against the platelets is reduced, leading to improved platelet counts in many patients. This is why splenectomy is considered a last resort after other treatments have not achieved the desired outcome.