Hi, 1st initial treatment is steroid and immuno-supressant. In this case it is refractory to both. Next solution is splenectomy (Removal of spleen which is culprit killing platelets). It 100% works for ITP. Hence, it is better to consult a general or gastro surgeon for surgery. If surgery goes well. It shows 100% result. Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Tata Lokesh Kumar, General Surgeon