Lau, unfortunately one can have more than one ITP antibody working against you. Combinations of rows (and responses) in the table are therefore possible. Don't fret too much though. Folks loose steroid response, IVIG response, or both, fairly often around here. Since there are no direct blood tests for all 4 antibodies, it becomes a guessing game of what has happened when a change in response occurs.
Rather than go through all the things that could have happened it might be more useful to explain what probably happened, then, reevaluate if evidence conflicts. I say 'probably' because it happens a lot. What probably happened is that your daughter had a row 1 response at the beginning. When she relapsed and lost her steroid response she likely became a row 1 and row 2a combination. With steroids not being able to help anymore with row 2a, she now needs a higher dose of Promacta/Nplate to get counts up.
The nice thing about row 2a or 2b is that it can often go away / go into remission after treating with just Nplate (or Promacta) alone. This can take many months. But it appears that combining steroids with Nplate (or Promacta) speeds the process. Doesn't seem to matter if it's row 2a or row 2b. Taking both seems to reduce the time to weeks.
If what I've described is actually the case, once her platelets start responding to the higher Nplate dose, the Nplate dose she needs to maintain counts should become less and less. During this transition period, holding counts in the 100 to 150 range is probably ideal.
I don't want to get 'too far over my skies'. I'm pretty far now, I'll stop here. Hope this helps.
