Experience with high dose dexamethasone in the treatment of chronic symptomatic immune thrombocytopaenia
Objective: To evaluate the efficacy of high dose dexamethasone (HDD) as treatment for symptomatic chronic immune thrombocytopaenia (ITP). Design: A non-randomised intervention study with final evaluation one year after treatment, comparing findings before and after intervention. Setting: Tygerberg University Hospital, South Africa. Participants: A consecutive sample of six children with chronic (duration more than six months) ITP. The diagnosis of ITP was based on a platelet count of < 100 × 109/1 together with appropriate clinical, laboratory and bone marrow findings. Interventions: All children treated with dexamethasone 0.5 mg/kg/day intravenously for four days every 28 days for a total of six cycles. Main outcome measures: A rise in platelet count maintained for a least one year associated with the disappearance of symptoms due to thrombocytopaenia. Results: Treatment was easy to administer and well tolerated with transient side effects in only two children. Three patients had a rise in platelet count of > 50 × 109/1 during treatment and three had platelet counts of > 30 × 109/1 after completion of therapy but only one at one month and one at six months after completion of the six courses respectively. None of the patients showed a sustained rise in platelet count during and after HDD treatment Conclusion: HDD did not cause a significant sustained rise in the platelet count in children with chronic symptomatic ITP. If high dose prednisone and IVIG fail, a splenectomy should be considered in children over five years of age.