Which of the following is a second-line option for ITP after first-line therapy?

Which of the following is a second-line option for ITP after first-line therapy?

• A. Corticosteroids
• B. Splenectomy
• C. Thrombopoietin-receptor agonists
• D. Both thrombopoietin-receptor agonists and splenectomy

Answer: (D)

After first-line therapy with corticosteroids, second-line options for ITP include approaches that address different parts of the disease process. Splenectomy reduces platelet destruction and autoantibody production by removing the spleen, which is a major site of platelet clearance. Thrombopoietin-receptor agonists boost platelet production in the bone marrow, helping maintain higher platelet counts without removing immune-mediated destruction. Because both strategies are used when initial therapy isn’t sufficient or relapses occur, they are both considered second-line options. Thus, choosing an option that includes both splenectomy and thrombopoietin-receptor agonists reflects the available second-line approaches.

After first-line therapy with corticosteroids, second-line options for ITP include approaches that address different parts of the disease process. Splenectomy reduces platelet destruction and autoantibody production by removing the spleen, which is a major site of platelet clearance. Thrombopoietin-receptor agonists boost platelet production in the bone marrow, helping maintain higher platelet counts without removing immune-mediated destruction. Because both strategies are used when initial therapy isn’t sufficient or relapses occur, they are both considered second-line options. Thus, choosing an option that includes both splenectomy and thrombopoietin-receptor agonists reflects the available second-line approaches.