OBJECTIVES:   To better understand current practice patterns and determine how current practice fits recently published guidelines, a treatment sequencing analysis of ITP patients in Spain was conducted. METHODS:   A retrospective chart review of patients diagnosed with ITP was undertaken at 8 hospitals in Spain, collecting demographic and clinical data, drug treatment (up to fifth line) and its duration. Thrombopoetin-receptor agonists were not available at the time of the review. RESULTS:   Data on 60 patients [90% (n=54) with baseline platelet counts <30x109/L and 10% (n=6) <50x109/L with bleeding episodes] were available. Patients were 54.4 ±20.7 (SD) years of age, 63% female, and 6.0 ±7.2 (SD) years since diagnosis. The most common first-line treatment was corticosteroids (n=39, 65%), followed by intravenous immunoglobulins (IVIg; n=19, 32%). The mean duration of first-line treatment with corticosteroids was 28.2 ±39.0 (SD) days. The most common sequence of treatment for patients initially treated with corticosteroids was administration of four additional courses with corticosteroids (18/39, 46%), followed by alternation between IVIg and corticosteroids until the fifth-line of treatment (7/39, 18%). Of the 19 patients with initial IVIg, 5 (26%) received corticosteroids in the 4 remaining treatments, 5 (26%) continued with IVIg, and 4 (21%) alternated corticosteroids and IVIg. In total, 41 patients (68%) received ≥2 treatments with corticosteroids and 10 (17%) received treatments other than corticosteroids and IVIg (3 patients received azathioprine, 3 rituximab, 2 platelet transfusions, 1 anti-D immunoglobulin, 1 danazol and 1 mycophenolate mofetil). CONCLUSIONS: Patterns of treatment of ITP in Spain usually followed recently introduced recommendations from international consensus guidelines. However, in most patients, corticosteroid treatment  was given repeatedly, which exceeds current recommendations, i.e., rapidly tapering corticosteroid dose and stopping after 4 weeks. Future research is needed with a larger sample size, to explore the place of splenectomy in treatment sequencing, and better understand the role of combination therapy.