In immune thrombocytopenia, what is the initial treatment regimen to raise platelets above 50, with tapering?

• A. Single dose IVIG 1 g/kg initially
• B. Splenectomy as first line
• C. Prednisone 1 mg/kg/d until platelets > 50 then taper over 4 weeks
• D. Thrombopoietin receptor agonists as first line

Answer: (C)

Initial therapy in immune thrombocytopenia aims to raise the platelet count quickly to reduce bleeding risk. Corticosteroids, such as prednisone at 1 mg/kg per day, dampen the immune response, reducing autoantibody production and slowing the destruction of platelets. As platelets rise to a safer level (above about 50,000/µL), the dose is tapered over several weeks—roughly four—to minimize steroid-related side effects and to help prevent relapse. While other therapies like IVIG can lift platelets quickly, they are typically used when a rapid rise is needed or as a bridge, not as the initial long-term plan. Splenectomy and thrombopoietin receptor agonists are generally reserved for cases that do not respond to initial medical therapy.