As far as the choice of corticosteroids is concerned, prednisone or prednisolone is preferred to dexamethasone, which crosses the placenta more readily [3]. While the ASH guideline recommends a starting dose of prednisone 1 mg/kg daily, there is no evidence that a higher starting dose is better than a lower dose [3]. Therefore, other experts recommend a starting dose of 0.25–0.5 mg/kg daily. In fact, the Japanese consensus report recommends 10–20 mg/day as a starting dose [5] since a Japanese nationwide study revealed that prednisolone dose of 15 mg/day or more might be associated with premature delivery, preeclampsia, or congenital abnormalities [6]. The international consensus report also recommends this lower starting dose [2].

The conventional dose of IVIG is 0.4 g/kg/day for 5 days, which is recommended in Japanese consensus report [5]. Alternatively, 1 g/kg/day for 2 days can be considered according to ASH and BSCH guidelines [3, 4]. The duration of response to IVIG is usually 2–3 weeks [2], and therefore after an initial response, repeat infusions might be required to prevent bleeding symptoms and keep an adequate platelet count if the patient should be managed only with IVIG.