Management of adverse reactions Glucocorticoids: The main adverse reactions caused by long-term high dose application include ① Secondary and aggravated infections: Common infections include bacteria, viruses and fungi. In patients with long-term high-dose hormone application, strong antibiotic therapy should be given as soon as possible once signs of infection appear. ②Pharmacogenic hyperadrenocorticism: such as centripetal obesity, full-moon face, buffalo back, skin acne as well as hypertension, hyperglycemia, water and sodium retention, and hypokalemia. Patients’ blood pressure, blood glucose and electrolyte levels should be monitored regularly, and if necessary, antihypertensive, hypoglycemic and diuretic treatments should be given. Osteoporosis and osteonecrosis: Even small doses of hormones can lead to osteoporosis when used for a long time, especially in menopausal women or children, so calcium and vitamin D should be given routinely for prevention. In severe cases, osteonecrosis of the femoral head may occur. (4) Inducing or aggravating ulcer disease: It may induce peptic ulcers or aggravate existing ulcers and lead to bleeding and perforation, etc. Therefore, patients with previous peptic ulcers should use glucocorticoids cautiously or add acid suppressants prophylactically. (5) Growth retardation: Long-term hormone use can lead to growth retardation in pediatric patients, so long-term hormone use should be avoided as much as possible in pediatric patients. (6) Psychoneurological symptoms; including agitation, euphoria, insomnia, etc. Individuals may induce psychosis, and symptomatic treatment such as Valium can be given if necessary. Splenectomy: Complications after splenectomy are rare and include the presence of thrombosis, intra-abdominal bleeding, abdominal infection or sepsis. The mortality rate associated with conventional splenectomy is approximately 1%, whereas the mortality rate of trans-laparoscopic splenectomy is approximately 0.2%. Laparoscopic splenectomy has the advantage of a shorter hospital stay and faster postoperative recovery compared with conventional surgical approaches. Laparoscopic splenectomy is generally considered safe when platelet counts are >20×109/L. For patients with platelet counts <20×109/L, preoperative administration of hormones and IVIg may be considered. To avoid fatal infections, indications should be strictly selected in pediatric ITP patients; prophylactic immunizations should be routinely given at least 2 weeks before surgery to all patients proposed for splenectomy; and anti-infective therapy should be given as early as possible to patients with postoperative fever, even if the etiology is unknown. Rituximab: Side effects include ①Infusion-related complications such as fever and chills, bronchospasm, laryngeal edema, hypotension, and arrhythmias. Therefore, cardiac monitoring and close attention to changes in vital signs should be given during the use of Meroval, and anti-allergic and antipyretic drugs can be routinely given before use for prevention. ②Secondary infection: Meroval may cause clearance of B lymphocytes and decrease in immunoglobulin levels, which may lead to an increased risk of infection, but is usually not significant. In hepatitis B virus (HBV) carriers there is a risk of HBV activation, therefore antiviral prophylaxis should be given to patients who are HBV surface antigen positive during treatment with melova. (iii) Progressive multifocal cerebral leukomalacia: rarer, with an increase in reports in recent years, and no specific treatment is available other than discontinuation of the drug. Azathioprine: most of its side effects are mild, mainly hepatic impairment and bone marrow suppression, etc., which can be recovered after discontinuation of the drug. Therefore, attention should be paid to testing blood images and liver and kidney functions during use. Cyclophosphamide: Common side effects of the drug include bone marrow suppression, hair loss, hemorrhagic cystitis, secondary second tumors, and infertility. Care should be taken to monitor the patient's blood picture, urinary routine, and liver and kidney function during use, and the prevention of hemorrhagic cystitis (hydration and antagonist use) should be noted when using high-dose intravenous dosing regimens. Vincristine: Common drug side effects include peripheral neuritis, hepatic impairment, and bone marrow suppression. The patient's blood image, liver and kidney function should be tested during use, and neurological signs and symptoms should be closely monitored. Danazol: The side effects are mainly liver function damage and androgen-like effects such as acne and hirsutism, which can cause amenorrhea and breast reduction in female patients. Cyclosporine A: more common side effects include renal impairment, hypertension, tremor, hirsutism, gastrointestinal disorders, liver function impairment, gingival hyperplasia, infection, etc. The blood concentration of cyclosporine A and the patient's liver and kidney function and blood pressure level should be monitored regularly during the use.