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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Should steroids be continued while suffering from ITP?

My son was diagnosed with itp on the 22nd of January. He has had 2 ivig wich produced no results. Then was placed on Prednisone. His counts went from 1 on the 22nd to 9 on the 26th. On the 27 he was at 7 then given a nplate injection. He registered at 7 on the 30. We then discussed to gradually reduce the steroids and move to 6mp. We gradually reduced the steroids then on the 2nd his counts had increased to 16 before we started 6mp. Because I was cautious to start the 6 MP it was decided we would hold off on introduction to that drug but the ween from the steroids was still continued. When we returned on the 10th his counts had dropped all the way to below 5. Hesitant to introduce my son who is 2 months away from 4 to a chemo drug a doctor suggested to try another steroid at a higher dose for 4 days. It was also stated that after that round we would go back on the Prednisone to ween his system back down. On the follow up visit on the 13th his counts registered at 57 his highest since this had started. The doctor then suggested to just finish the last high dose and not move to Prednisone. He has had a nplate injection every week I should add. On the 16th his counts had dropped back to 5. Later that evening he had started to develop symptoms that made us go to the ER initially. Blood blisters on his lips and in his mouth , bruising, and spots of petechiae. All things we were told we should contact them about. We called and the just say to keep an eye on him and call if there s any bleeding. Am I missing something here? I guess I am just looking for reassurance that he is receiving the best treatment he can? Should he not be taken off the steroids? This is breaking my heart and scarring me to death and I am looking for some kind of help with this. Thank you. Kevin
Mon, 23 Jul 2018
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General & Family Physician 's  Response
Hello and Welcome to ‘Ask A Doctor’ service.
I have reviewed your query and here is my advice.

ITP, immune thrombocytopenic purpura is a clinical syndrome with low blood platelet count manifests as a bleeding tendency,easy bruising and petechiae. Is important to measure the platelet count, because depending on it and on clinical features, all the treatment depends. A platelet count higher than 50,000 and with no bruising or petechiae need no treatment but close observation. Also even at this count or higher but with clinical symptoms, medical treatment is necessary and prednisone is the first choice.

Hope I have answered your query. Let me know if I can assist you further.
Regards,
Dr. Suzana Zharri
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Should steroids be continued while suffering from ITP?

Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice. ITP, immune thrombocytopenic purpura is a clinical syndrome with low blood platelet count manifests as a bleeding tendency,easy bruising and petechiae. Is important to measure the platelet count, because depending on it and on clinical features, all the treatment depends. A platelet count higher than 50,000 and with no bruising or petechiae need no treatment but close observation. Also even at this count or higher but with clinical symptoms, medical treatment is necessary and prednisone is the first choice. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Suzana Zharri