In refractory thrombocytopenia one should first evaluate whether the therapeutic approach has more risks to the patient than no treatment at all. The patient may remain relatively asymptomatic and the only incommoding circumstances be cosmetic. Coincidental medical problems such as hypertension and peptic ulceration are particularly worrying in the patient with ITP. Very occasionally a cerebral haemorrhage may occur without any obvious predisposing cause. In most instances, however, refractory thrombocytopenia is a benign condition which rarely directly causes the death of the patient. Since many of the remedies advocated for this problem have significant side effects these must always be carefully balanced and fully discussed with the patient before their introduction.