The Effect of High Dose Dexamethasone in Childhood Acute Idiopathic Immune Thrombocytopenia

You, Chur Woo

Abstract

PURPOSE: For preventing CNS hemorrhage, steroids and high dose immune globulin have been used as the first-line treatments of acute ITP. Most of the patients respond to these treatments with rapid rise of platelet count to safe level compared to patients who received no treatment. Although the exact incidence has not been known, there are patients who are not responding these first-line treatments. Insufficient humoral immune suppression is thought to be the main mechanism of this failure and it has been known that humoral immunity is suppressed only at high dose steroids. Therefore, high dose steroids, especially dexamethasone which has been reported recently as an effective treatment in chronic refractory ITP, can overcome this treatment failure. METHPDS: Among the 62 acute ITP patients who were admitted in pediatric department of Masan Samsung Hospital between March, 1998 and March, 2000, only 8 patients were resistant to high dose immune globulin and conventional dose of prednisone. High dose dexamethasone 25 mg/M(2)/day in three divided doses was given to the 8 treatment failure patients for consecutive 4 days and platelet count was followed at 3, 5 and 7days after beginning of the treatment and then weekly. Only when the initial medication cycle was effective the dexamethasone was given to the patients repeatedly with the same dose and schedule until the resolution of the disease.
RESULTS
Platelet counts were increased to safe level (> 50x10(9)/L) within 5 days of the treatment in all the patients with the initial treatment of high dose dexamethasone and this effect was observed in subsequent cycles. The mean days of maintaining platelet count above 20x10(9)/L was 22.0+/-3.1 days. Weight gaining and facial flushing were observed in 57% and 30% of patients but hypertension and glucosuria were not observed.
CONCLUSION
These results suggest that high dose dexamethasone may be effective in the treatment of childhood acute ITP who did not respond to conventional dose of prednisone previously.