The Fellow on Call: The Heme/Onc Podcast
Jun 24, 2026 · 26 min · 12 segments
This week, we move to the relapsed/refractory ITP setting, focusing on what options are available to patients after their initial treatment with steroids ± IVIg, which we discussed in Episode 155. If…
Guys, last time we were talking all about ITP, and we talked about how we approach these patients in the first line setting.
Today, we move on to that unfortunate situation which frankly happens quite frequently, where patients develop relapse of their disease pretty quickly, and sometimes even down the line.
But nonetheless, what do we do in these situations? If I may, I'm gonna remind you of the case that we were talking about last time, and then we'll set the stage for where we go from here, okay? So we had a 23-year-old female with no significant past medical history that had come to the ER with several days of spontaneous bruising on her arms and legs, and a new rash on her lower extremities.
She had also endorsed some epistaxis and some gum bleeding on her review of systems.
No recent infections, no new medications, no family history of bleeding disorders.
And ultimately, when we had gotten a CBC on her, she had an isolated thrombocytopenia with a platelet count of 12.
And despite the workup that we talked about lice- last time, everything was consistent with what looked like ITP.
And because her platelets were very, very low, we had treated her with steroids, and we also talked about in patients with very, very low platelets that we typically define as a platelet count less than 10, we can also talk about the role of IVIG in those patients.
So, you know, in this case, our patient, let's say that she ended up getting dex times four days.
She got IVIG times two days.
She's discharged on hospital day five, at which time her platelets were 45.
Remember, per ASH guidelines, we want them to be at least double from baseline and greater than 20.
And so she's at 45, no new bleeding.
She's doing really, really well.
And the following week, you notice that her platelet count was 80, and then the week after that, it comes back at 28.
You give her a call.
She's got no new symptoms, so now what do we do?
Guys, last time we were talking all about ITP, and we talked about how we approach these patients in the first line setting.
Today, we move on to that unfortunate situation which frankly happens quite frequently, where patients develop relapse of their disease pretty quickly, and sometimes even down the line.
But nonetheless, what do we do in these situations? If I may, I'm gonna remind you of the case that we were talking about last time, and then we'll set the stage for where we go from here, okay? So we had a 23-year-old female with no significant past medical history that had come to the ER with several days of spontaneous bruising on her arms and legs, and a new rash on her lower extremities.
She had also endorsed some epistaxis and some gum bleeding on her review of systems.
No recent infections, no new medications, no family history of bleeding disorders.
And ultimately, when we had gotten a CBC on her, she had an isolated thrombocytopenia with a platelet count of 12.
And despite the workup that we talked about lice- last time, everything was consistent with what looked like ITP.
And because her platelets were very, very low, we had treated her with steroids, and we also talked about in patients with very, very low platelets that we typically define as a platelet count less than 10, we can also talk about the role of IVIG in those patients.
So, you know, in this case, our patient, let's say that she ended up getting dex times four days.
She got IVIG times two days.
She's discharged on hospital day five, at which time her platelets were 45.
Remember, per ASH guidelines, we want them to be at least double from baseline and greater than 20.
And so she's at 45, no new bleeding.
She's doing really, really well.
And the following week, you notice that her platelet count was 80, and then the week after that, it comes back at 28.
You give her a call.
She's got no new symptoms, so now what do we do?
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