What procedure is typically done last in cases of severe ITP?

In cases of severe immune thrombocytopenic purpura (ITP), splenectomy is recognized as a procedure that is often performed when other treatments have failed or are not sufficient to manage the condition effectively. The spleen plays a significant role in the destruction of platelets, and removing it can result in a substantial increase in platelet count for many patients.

Corticosteroid treatment and IVIG (intravenous immunoglobulin) are typically used as initial treatment strategies aimed at increasing platelet counts and managing symptoms. These approaches are often effective, but they may not provide long-term solutions for all patients. If these treatments do not achieve desired results, or if the patient experiences chronic issues, splenectomy becomes a viable option.

Bone marrow transplant is generally not considered for ITP unless there are complicating factors such as aplastic anemia or other bone marrow disorders, making it less relevant in the context of standard ITP management.

Thus, splenectomy is typically the last resort in the treatment hierarchy when conservative management and other interventions have not succeeded in adequately controlling the disease. This understanding of the treatment sequence offers insight into why splenectomy is viewed as a definitive measure for severe cases of ITP.