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  • Title: Experience with high dose dexamethasone in the treatment of chronic symptomatic immune thrombocytopaenia.
    Author: Van Riet FA, Wessels G, Hesseling PB.
    Journal: East Afr Med J; 1999 Oct; 76(10):571-4. PubMed ID: 10734508.
    Abstract:
    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 x 10(9)/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 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. 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.
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