Hemorrhage in the Setting of Acute Severe Refractory Immune Thrombocytopenic Purpura: A Case Report

Immune thrombocytopenic purpura (ITP) is a hematologic disorder characterized by platelet-directed autoantibodies that result in thrombocytopenia via splenic consumption. Patients with ITP usually have a platelet count < 100,000 u/L, with lower counts associated with more severe ITP. While ITP can have a mild clinical spectrum with minor bruising and petechiae, it may also be associated with potentially fatal pulmonary or cerebral hemorrhage. This manuscript presents a comprehensive review of the pathophysiology, diagnosis, and current therapeutic strategies currently available to treat ITP. We present a case of severe and acute refractory ITP in the setting of persistent multifocal bleeding and a platelet count that eventually responded following eight distinct therapies.