In immune thrombocytopenia (ITP) with mucosal bleeding in adults, which treatment is commonly used as initial therapy?

• A. IVIG for severe bleeding
• B. Corticosteroids
• C. Thrombopoietin receptor agonists in chronic cases
• D. Avoid NSAIDs

Answer: (B)

The main idea is to rapidly raise the platelet count by dampening the immune attack on platelets. In adults with ITP and mucosal bleeding, corticosteroids are used first because they blunt autoantibody production and reduce the splenic destruction of platelets, typically leading to a meaningful rise in platelets within days. This makes them the standard initial therapy to control bleeding and lower hemorrhagic risk.

Intravenous immunoglobulin can be added when a faster or more guaranteed platelet rise is needed urgently—for example, during active severe bleeding or when a quick pre-procedure boost is required—but it is not the routine initial choice for all patients due to cost and the temporary effect.

Thrombopoietin receptor agonists are aimed at boosting platelet production and are generally reserved for chronic or refractory ITP or when initial therapy is insufficient, not as the first-line treatment in an acute mucosal-bleeding presentation.

Avoiding NSAIDs is important in ITP because of bleeding risk, but that’s a precautionary measure rather than a treatment to increase platelets.