Your son is suffering from Chronic ITP. He has partial response to steroid, IVIg and Anti D earlier. This form of ITP is Chronic Refractory ITP. It shall be important to know that whether bone marrow examination was done before starting steroids in presence of Lymph nodes or not.
In chronic ITP rule is that you treat bleeding symptoms rather than treat the number of platelets and try to correct them. The treatment options for chronic refractory ITP are -
- Splenectomy
- Dapsone
- Rituximab
- Vincristine
- Cyclosporine
- High dose Dexamethasone
- Azoran
We delay splenectomy in children if they are not bleeding. Choice of second line drug depends on the doctor.