Espinoza-Valdespino L, García-Reyes B, Nava-Zavala AH, Rubio-Jurado B

Language: Spanish
References: 17
Page: 28-35
PDF size: 248.23 Kb.

ABSTRACT

Primary immune thrombocytopenia (PIT) is an acquired autoimmune disorder characterized by isolated thrombocytopenia secondary to immune destruction of platelets. It is the benign disease most often treated in this hospital. According to the literature, most patients respond to first-line treatment with corticosteroids; a lower proportion of them require second-line treatment. In our service, the first-line treatment in patients with primary immune thrombocytopenia de novo is methylprednisolone 1/24 hour/3 doses, followed by prednisone 1 mg/kg/day for 15-21 days. The most recent publications on the management of primary immune thrombocytopenia suggest a dosage of 30 mg/kg/day for seven doses, without prednisone at 1 mg/kg/day. This dosage, adopted by our service, foreseeing the metabolic disorder and other adverse effects that could be brought about by higher doses of methylprednisolone, has been published in several articles; an example of these is the work of Robert Stasi, who reviewed the treatments for immune primary thrombocytopenia in 2004, where he took the dose of methylprednisolone of one gram per day for three days as emergency treatment when there is life-threatening bleeding or the patient needs to undergo emergency surgery; this in combination with platelet transfusion. This paper is for informational purposes only; it is not intended as a treatment guideline or to change the treatment recommendations of each center.

REFERENCES

1. Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010; 115 (2): 168-186.

2. Neunert C, Lim W, Crowther M, Cohen A, Solberg L, Jr., Crowther MA. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011; 117 (16): 4190-4207.

3. Rodeghiero F, Ruggeri M. Treatment of immune thrombocytopenia in adults: the role of thrombopoietin-receptor agonists. Semin Hematol. 2015; 52 (1): 16-24.

4. Rodeghiero F, Ruggeri M. ITP and international guidelines: what do we know, what do we need? Presse Med. 2014; 43 (4 Pt 2): e61-67.

5. Hua F, Ji L, Zhan Y, Li F, Zou S, Wang X et al. Pulsed high-dose dexamethasone improves interleukin 10 secretion by CD5+ B cells in patients with primary immune thrombocytopenia. J Clin Immunol. 2012; 32 (6): 1233-1242.

6. Nakazaki K, Hosoi M, Hangaishi A, Ichikawa M, Nannya Y, Kurokawa M. Comparison between pulsed high-dose dexamethasone and daily corticosteroid therapy for adult primary immune thrombocytopenia: a retrospective study. Intern Med. 2012; 51 (8): 859-863.

7. Su Y, Xu H, Xu Y, Yu J, Dai B, Xian Y et al. A retrospective analysis of therapeutic responses to two distinct corticosteroids in 259 children with acute primary idiopathic thrombocytopenic purpura. Hematology. 2009; 14 (5): 286-289.

8. Mashhadi MA, Kaykhaei MA, Sepehri Z, Miri-Moghaddam E. Single course of high dose dexamethasone is more effective than conventional prednisolone therapy in the treatment of primary newly diagnosed immune thrombocytopenia. Daru. 2012; 20 (1): 7.

9. Mazzucconi MG, Fazi P, Bernasconi S, De Rossi G, Leone G, Gugliotta L et al. Therapy with high-dose dexamethasone (HD-DXM) in previously untreated patients affected by idiopathic thrombocytopenic purpura: a GIMEMA experience. Blood. 2007; 109 (4): 1401-1407.

10. Alpdogan O, Budak-Alpdogan T, Ratip S, Firatli-Tuglular T, Tanriverdi S, Karti S et al. Efficacy of high-dose methylprednisolone as a first-line therapy in adult patients with idiopathic thrombocytopenic purpura. Br J Haematol. 1998; 103 (4): 1061-1063.

11. Von dem Borne AE, Vos JJ, Pegels JG, Thomas LL, van der L. High dose intravenous methylprednisolone or high dose intravenous gammaglobulin for autoimmune thrombocytopenia. Br Med J (Clin Res Ed). 1988; 296 (6617): 249-250.

12. Tandon R, Verma K, Chawla B, Sharma N, Titiyal JS, Kalaivani M et al. Intravenous dexamethasone vs methylprednisolone pulse therapy in the treatment of acute endothelial graft rejection. Eye (London). 2009; 23 (3): 635-639.

13. Frederiksen H, Christiansen CF, Norgaard M. Risk and prognosis of adult primary immune thrombocytopenia. Expert Rev Hematol. 2012; 5 (2): 219-228.

14. Stasi R. Pathophysiology and therapeutic options in primary immune thrombocytopenia. Blood transfusion. Trasfusione del Sangue. 2011; 9 (3): 262-273.

15. Zaja F, Battista ML, Pirrotta MT, Palmieri S, Montagna M, Vianelli N et al. Lower dose rituximab is active in adults patients with idiopathic thrombocytopenic purpura. Haematologica. 2008; 93 (6): 930-933.

16. Carson KR, Evens AM, Richey EA, Habermann TM, Focosi D, Seymour JF et al. Progressive multifocal leukoencephalopathy after rituximab therapy in HIV-negative patients: a report of 57 cases from the Research on Adverse Drug Events and Reports project. Blood. 2009; 113 (20): 4834-4840.

17. Kojouri K, Vesely SK, Terrell DR, George JN. Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications. Blood. 2004; 104 (9): 2623-2634.