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Most children with acute immune thrombocytopenic purpura (ITP) respond to first-line therapies including intravenous immunoglobulin, corticosteroids, and Rho(D) immune globulin. However, there is no clear consensus regarding second-line therapies for the treatment of ITP, not responding to first-line therapies in the acute setting. Adapting from the chronic ITP literature, 3 patients with acute refractory ITP were treated with intravenous rituximab and showed immediate and sustained remission. Combined therapy that includes rituximab may be an effective regimen for acute refractory ITP.

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