A 41-year-old lady has known history of Chronic Immune Thrombocytopenia (ITP) for three years and received treatment with corticosteroids. Her platelet count has been well maintained by prednisolone 10 mg daily in the recent one year. She has increasing skin bruising in recent one month and presented to accident and emergency department because of passing tarry stool for one day. Complete blood count showed haemoglobin was 6.2 g/dL (Reference: 11.9– 15.0) and platelet count was 3× 10⁹ /L (reference: 150 to 384). Intravenous Immunoglobulin (IVIG) was commenced.

a) Discuss the adverse effects of IVIG and strategy to reduce risk of adverse effects (7 marks)

b) If her platelet count failed to be maintained with corticosteroid alone, name two other immunosuppressive drugs which can be used and discussed the adverse effects (8 marks)

c) Name a class of non-immunosuppressive drugs which has been approved for the treatment of ITP and describe the major mechanism of action. Give ONE example of the drugs and discuss the adverse effects. (5 marks)