Comparison of anti-D immunoglobulin and dexamethasone in chronic and persistent forms of pediatric immune thrombocytopenic purpura

Bakcground: The aim of ITP treatment is to prevent intracranial hemorrhage and increase the platelet count rapidly. This study was conducted with the objective of comparing the efficacy of anti-D immunoglobulin (Ig) with dexamethasone in treating childhood ITP. Materials and Methods: In this randomized prospective control trial, 20 ITP patients (Platelet count<20,000/μl) younger than 16 were selected from those who referred to Dr. Sheikh Children Training and Research Hospital in Mashhad, Iran From February 2013 to January 2014. Patients were divided into two groups according to the type of administered treatment: group A received intravenous dexamethasone 40 mg/m2/ daily for four days. Group B received a single dose of intravenous anti-D Ig 50 μg/kg. The resultant data were then evaluated using SPSS (version 11.5). Results: In this study, 20 patients [11 girls (55%) and 9 boys (45%)] with the mean age of 5.6±4 years were enrolled. From the total number, 13 (65%) were younger than 5 years old, 4 (20%) aged between 5 and 10, and 3 (15%) were older than 10. There was no significant difference between the two groups regarding sex and age. In both groups the most common symptom was cutaneous manifestations (purpura, ecchymoses) (63.6% vs. 36.4% p=0.325). At enrolment time, the mean disease duration was 28±21 months, ranging from 5 to 132 months. Out of 20 patients, 9 (45%) suffered from chronic ITP, and 11 (55%) were in persistent phase of the disease. No significant difference was observed between the two groups regarding the frequency of chronic and persistent cases (p=0.370). Similarly, the follow-up platelet count four months after the treatment showed no significant difference between the two groups (p=0.241). Conclusion: The findings of this study did not confirm the priority of dexamethasone over anti-D Ig. The hemolytic side effects of anti-D were negligible compared to dexamethasone.