Refractory Idiopathic Thrombocytopenic Purpura

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Abstract
To the editor: Most patients with idiopathic thrombocytopenic purpura have sustained remissions after splenectomy. Most patients with persistent thrombocytopenia after splenectomy respond to steroids, cytotoxic agents, or vinca alkaloids when given as single agents (1-3). This report describes a case of refractory idiopathic thrombocytopenic purpura that did not respond to single-agent therapy but did respond to combination therapy with vinblastine infusions plus cyclophosphamide and prednisone. A 43-year-old Japanese-American woman presented in February 1979 with easy bruising. She had been taking hydrochlorothiazide for mild hypertension. Physical examination revealed only petechiae and bruises. Hemoglobin level was 14.1 g/dL, hematocrit 40%, leukocyte count

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