Refractory ITP — RACP Adult Medicine MCQ

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ModerateHaematologyRefractory ITPRACP Adult Medicine

A 45-year-old man presents with petechiae and mucosal bleeding. His platelet count is 8 × 10⁹/L. He was diagnosed with ITP 3 months ago and has relapsed after corticosteroid taper. He has also failed IVIg. What is the most appropriate next-line treatment?

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Correct answer: C — Thrombopoietin receptor agonist (eltrombopag or romiplostim)

For adult ITP refractory to corticosteroids and IVIg, thrombopoietin receptor agonists (TPO-RAs) – eltrombopag (oral) or romiplostim (SC injection) – are preferred second-line therapy. They stimulate megakaryocyte proliferation and platelet production. Response rates are 70–80%. They avoid the immunosuppressive risks of rituximab and the surgical morbidity of splenectomy. TPO-RAs are PBS-listed for chronic ITP in Australia after failure of first-line therapy. Rituximab and splenectomy are alternatives.

Reference: eTG – 2025 – Haematology; ASH – 2019 – ITP Guidelines