The role of high-dose dexamethasone in auto-immune refractory thrombocytopaenia

• Autor(a) principal: Pinheiro, Luís
• Data de Publicação: 2003
• Outros Autores: Ribeiro, João, Rebocho, Luísa, Lucas, Margarida, Victorino, Rui
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://revista.spmi.pt/index.php/rpmi/article/view/1784
• topic: Trombocitopenia auto-imune refractária; Púrpura trombocitopénica imune; Pulsos de dexametasona; Refractory autoimmune thrombocytopaenia; Immune thrombocytopaenic purpura; Dexamethasone pulses

The therapeutic approach to AutoimmuneThrombocytopaenic Purpura (ITP) refractoryto corticosteroids and splenectomy is controversial. Several second line therapies, includingimmunosuppression, have received attention in the international literature.We describe a case of a 36-year-old womanwith a 9-year history of ITP, refractory to corticosteroids and splenectomy, as well as to immunossupression with azathioprine for 2 years. Intravenous immunoglobulin (IVIG) wasused during the episodes of thrombocytopaenia with platelet levels below 10x109/L, with agood, yet transient response and an increasingnumber 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 lineregimen, described in the literature, of pulsedhigh doses of oral dexamethasone (40 mg/dayfor 4 days), with a 28 day interval, for 6 months, was started. After the last course and witha follow-up of 2 years, the platelet counts haveremained persistently above 100x109/L, without evidence of haemorrhage.This particular case provides additional evidence favouring the use of oral mega-doses ofdexamethasone as an effective and simple therapeutic option for refractory ITP, with favourable effects extended beyond the period of therapy.