**6. Conclusion**

In summary, the diagnosis and management of chronic ITP require a highly individualized approach that is often based on the natural history of the disease in the particular patient as well as the experience of the physician. Published guidelines can certainly provide some guidance to the physicians but the decision of when and how to treat the thrombocytopenia will still depend upon the hematologists. Although ITP is an old disease, our recent understanding of the pathogenesis has caused a marked paradigm shift. For decades, steroids and IVIg have remained frontline treatment. Recently, the developments of newer therapies, such as rituximab and thrombopoietic agonists, have had a major impact on the management of ITP. A combination of different agents may be a useful approach in the future but a single uniform set of guidelines is difficult to establish. To date, optimizing the curative effects of the different therapies available remains a challenge.
