Prednisone was first treatment for ITP and did nothing but cause intense itching all over. Did Ivig next and platelet count went up to mid 20's. Tried Nplates and saw great improvement to 110. Continued Nplate for a few months when hematologist decided to try Promacta instead, only to see platelets drop to 50-60 and significant out of pocket copays for the prescription. When I complained the financial counselor arranged for free Promacta from manufacturer. After a year on Promacta I also started again receiving the weekly Nplate infusions of 315mmg and platelets went up again to a little above 100. This past August I was told to discontinue the Promacta and just come in for weekly Nplate infusions. Platelets seem to be holding in mid 70's when tested with citrate otherwise clumping will not show any platelets in CBC. I guess I'm lucky to not have any symptoms other than a bruise here and there. I'm still sensitive to the cold because of CAD but I wear warm cloths in the cold weather and get by. I'm not sure what the MGUS has to do with the ITP and CAD. Is it the cause or just another issue? But like I said before I would have never known anything was wrong with me until the low platelets showed up on a routine CBC. And yes, we made it safely through covid. My wife and I both received the Pfizer vaccinations and booster.