Objective: We evaluated the clinical features and the effects of various treatment modalities on the clinical course in patients diagnosed with idiopathic thrombocytopenic purpura (ITP). Materials and Methods: Retrospective investigation of the medical records of 168 patients at our center between 1994 and 2005 was done. Results: Of the 168 patients, 115 (68.4%) were women and 53 (31.6%) men. At initial diagnosis, the median age of the patients was 33 years (range: 15-91) and 139 (82.7%) had signs of bleeding. Followup was complete in 130 patients and the median follow-up was 27 months (range: 3-132). Initial treatment with either standard or high-dose steroid as first-line therapy was begun in 123 (73.2%) of the 168 patients. Complete remission (CR) was achieved in 56% of the patients. Sixty-one (61) patients who were followed up regularly received second-line therapies. CR was achieved in 45.8% of the patients who received steroids as second-line therapy. Within a median follow-up of 7 months, 27.2% of these patients relapsed. Splenectomy was performed in 26 patients and CR was obtained in 72% of the 25 patients regularly followed up. CR obtained by splenectomy was significantly higher than that obtained by steroids (p < 0.001). The 10-year disease-free survivals in patients who used steroids and who underwent splenectomy were 15 and 61.6%, respectively. Conclusion: Steroid therapy is effective both in the initial and relapse periods. Splenectomy is the treatment of choice for those ITP patients refractory to steroid therapy and younger than 40 years of age. Copyright (C) 2007 S. Karger AG, Basel.