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Although patients with refractory immune thrombocytopenic purpura (ITP) typically do not experience major bleeding episodes, recurrent mucosal bleeding (which occurs when platelet counts are <20,000/μL) causes much distress. Furthermore, if splenectomy or other major surgery is contemplated, raising platelet counts to >50,000/μL is mandatory. Oral or intravenous corticosteroids generally will raise platelet counts to hemostatically effective levels within 2 weeks, but a few patients have minimal or no response to these drugs. Such patients usually are treated sequentially with other agents, including intravenous immunoglobulin G (IVIG), anti-D, and vinca alkaloids. In a new study, researchers evaluated the effectiveness of concurrent combin…