How do you choose between therapies for newly diagnosed ITP that is refractory to steroids and IVIG?

The important questions here are what are the symptoms and what are the platelet counts? In patients who fail to respond to either corticosteroids or IVIG, the concern is whether this is actually immune thrombocytopenia or another cause of thrombocytopenia. With "normal" flow and bone marrow results, one of the many familial thrombocytopenia syndromes is still possible. Assuming this has also been ruled out, TPO-RA would be the recommended next step (although the response to TPO-RA without respo...