The role of high-dose dexamethasone in auto-immune refractory thrombocytopaenia
Keywords:
Refractory autoimmune thrombocytopaenia, Immune thrombocytopaenic purpura, Dexamethasone pulsesAbstract
The therapeutic approach to Autoimmune
Thrombocytopaenic Purpura (ITP) refractory
to corticosteroids and splenectomy is controversial. Several second line therapies, including
immunosuppression, have received attention in the international literature.
We describe a case of a 36-year-old woman
with a 9-year history of ITP, refractory to corticosteroids and splenectomy, as well as to immunossupression with azathioprine for 2 years. Intravenous immunoglobulin (IVIG) was
used during the episodes of thrombocytopaenia with platelet levels below 10x109/L, with a
good, yet transient response and an increasing
number of hospital admissions (18 during 2 years). In view of the absence of a sustained response to the 1st and 2nd line therapeutic options and the transient response to IVIG, a 3rd line
regimen, described in the literature, of pulsed
high doses of oral dexamethasone (40 mg/day
for 4 days), with a 28 day interval, for 6 months, was started. After the last course and with
a follow-up of 2 years, the platelet counts have
remained persistently above 100x109/L, without evidence of haemorrhage.
This particular case provides additional evidence favouring the use of oral mega-doses of
dexamethasone as an effective and simple therapeutic option for refractory ITP, with favourable effects extended beyond the period of therapy.
Downloads
References
Mc Millan R and Imbach P. Immune Thrombocytopenic Purpura Chapter 30. In: Loscalzo J; Schafer AI eds. Thrombosys and Hemorrage.
Baltimore: Williams & Wilkins. 1998:643-664.
McMillan R. Therapy for Adults with Refractory Chronic Immune Thrombocytopenic Purpura. Ann Int Med 1997; 126:307-314.
George JN, Woolf SH, Raskob GE et al. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the
American Society of Hematology. Blood 1996; 88:3-40.
Andersen JC. Response of resistant idiopathic thrombocytopenic purpura to pulsed high-dose dexamethasone therapy. N Engl J Med 1994;
:1560-1564.
Bulvik S, Ben-Tal O, Shimoni Z, Eldor A. Pulsed high-dose dexamethasone in resistant immune thrombocytopenic purpura. Harefuah 1996;
(71):18-20.
Arruda VR, Annichino-Bizzacchi JM. High-dose dexamethasone therapy in chronic idiopathic thrombocytopenic purpura. Ann Hematol 1996;73:175-177.
Warner M, Wasi P, Couban S, Hayward C, Warkentin T, Kelton JG. Failure of pulse high-dose dexamethasone in chronic idiopathic immune thrombocytopenia. Am J Hematol 1997; 54:267-270.
Caulier MT, Rose C, Roussel MT, Huart C, Bauters F, Fenaux P. Pulsed high-dose dexamethasone in refractory chronic idiopathic thrombocytopenic purpura: a report of ten cases. Br J Haematol 1995; 91:447-449.
Dubbeld P, van der Heul C, Hillen HF. Effect of high-dose dexamethasone in prednisone-resistant autoimmune thrombocytopenic purpura
(ITP). Neth J Med 1991; 39:6-10.
Bulvik S, Winder A, Ben-Tal O, Szold A, Eldor A. High-dose dexamethasone for splenectomy in patients with idiopathic thrombocytopenic
purpura. Haemostasis 1998; 28:256-259.
Byrne JD, Incerpi MH, Goodwin TM. Idiopathic thrombocytopenic purpura in pregnancy treated with pulsed high-dose oral dexamethasone. Am J Obstet Gynecol 1997; 177:468-469.
Additional Files
Published
How to Cite
Issue
Section
License
![Creative Commons License](http://i.creativecommons.org/l/by/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2023 Medicina Interna