Immune Thrombocytopenic Purpura

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Abstract
We were disappointed that the use of pulsed high-dose dexamethasone in patients with chronic, refractory immune thrombocytopenic purpura was not mentioned in the review article on this condition by Cines and Blanchette (March 28 issue).1 We have treated three adults who had relapses of immune thrombocytopenic purpura after splenectomy with six cycles of pulsed high-dose dexamethasone, and two of these patients had complete remission lasting for as long as four years of follow-up ( Table 1 ). Warner et al.2 refuted the claim that pulsed high-dose dexamethasone has a role in treating chronic immune thrombocytopenic purpura; they studied nine patients, but only three patients received the full six cycles of dexamethasone. Furthermore, only four patients underwent splenectomy before receiving dexamethasone. Given previous data from Andersen3 and the guidelines published by the American Society of Hematology,4 pulsed high-dose dexamethasone should still be in the algorithm for treatment of chronic, refractory immune thrombocytopenic purpura.