Experience with high dose dexamethasone in the treatment of chronic symptomatic immune thrombocytopaenia

To evaluate the efficacy of high dose dexamethasone (HDD) as treatment for symptomatic chronic immune thrombocytopaenia (ITP).

A non-randomised intervention study with final evaluation one year after treatment, comparing findings before and after intervention.

Tygerberg University Hospital, South Africa.

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 x 10(9)/1 together with appropriate clinical, laboratory and bone marrow findings.

All children treated with dexamethasone 0.5 mg/kg/day intravenously for four days every 28 days for a total of six cycles.

A rise in platelet count maintained for a least one year associated with the disappearance of symptoms due to thrombocytopaenia.

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 x 10(9)/1 during treatment and three had platelet counts of > 30 x 10(9)/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.

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.