Steroid Responsiveness In Patients With Immune Thrombocytopenic Purpura
ITP is an immunological disorder characterized by production of antibodies targeted towards platelets. Corticosteroids and intravenous immunoglobulins were the mainstay of immediate treatment after 1950’s with splenectomy for more than 100 years remains the only option with curative potential.
To analyse the effect of treatment with steroids and its impact on natural history of the disease.
Materials and Methods
*Prospective study consisting of 40 cases of ITP admitted to Kasturba Medical College Hospital, Manipal
*Patients above 14 years of age admitted with thrombocytopenia in this institution were screened based on detailed clinical history, physical examination and laboratory investigations.
All patients were started on prednisolone at 1 ml/kg as initial therapy. 20 (50%) of the above 40 patients responded to corticosteroids alone and did not have any further relapse. The corticosteroids were tapered over a period of 4 to 6 weeks and stopped. Among the remaining patients 3 (7.5%) had a relapse of symptoms within next 6 months and responded to repeat prednisolone started at 1mg/kg and tapered over 6 weeks. These patients responded completely and did not have any further symptoms .Another 4 (10%) patients who relapsed were started on dapsone along with steroids as therapy among which 1 (2.5%) patient was also started on danazol , all patients responded to therapy over a period of 6 to 8 weeks without further relapse . 2 (5%) patients were given steroids tapering dose with IV Immune globulins for initial 5 days as therapy to which they responded.
Corticosteroids are the mainstay in the treatment of ITP. Complete remission is seen in up to 57.5% of the patient. Patients who do not have an adequate response can be treated with either immunosuppressive drugs or maintenance dose of corticosteroids.
Keywords - Corticosteroid, Remission, IV Ig