How I Treat Immune Thrombocytopenia: An Individualized, Patient-Centered Approach

Immune thrombocytopenia (ITP) is an acquired autoimmune disorder characterized by isolated thrombocytopenia resulting from immune-mediated platelet destruction and impaired platelet production. The clinical course of ITP is highly heterogeneous, ranging from asymptomatic disease to severe, relapsing thrombocytopenia with bleeding complications. Management of ITP remains challenging and requires an individualized, patient-centered approach that balances bleeding risk, treatment efficacy, long-term safety, and quality of life. We present a case series of three patients with chronic ITP from real-world clinical practice, illustrating different therapeutic pathways and decision-making strategies. Methods: The three patients included in this case series had persistent or chronic ITP with variable disease duration, bleeding risk, and treatment responses. Initial management strategies followed current guideline recommendations, including corticosteroid therapy and intravenous immunoglobulins when indicated. Subsequent lines of therapy were selected based on treatment response, patient comorbidities, lifestyle considerations, and tolerance, and included thrombopoietin receptor agonists (TPO-RAs) and, in selected cases, splenectomy. Results: Across the three cases, corticosteroid therapy resulted in transient platelet responses, with relapse occurring after dose tapering or treatment withdrawal. Second-line therapeutic strategies, particularly TPORAs, led to clinically meaningful increases in platelet counts, enabling bleeding control and procedural safety. Treatment responses varied in terms of durability and required individualized dose adjustments and therapeutic switching. Shared decision-making played a central role in treatment selection, taking into account patient preferences, logistical considerations, and adverse effect profiles. Overall, satisfactory platelet responses were achieved, allowing for stabilization of disease and improvement in clinical outcomes. Conclusions: This case series highlights the complexity and heterogeneity of ITP management in routine clinical practice. Our findings underscore the importance of personalized treatment strategies, timely escalation of therapy, and the judicious use of TPO-RAs in patients with inadequate or unsustained responses to first-line treatments. Real-world evidence from such case-based experiences complements clinical trial data and supports a flexible, patient-centered approach to optimizing long-term outcomes in ITP management.