الفهرس 
ACKNOWLEDGMENT
Phases of ITPOnly 14 pages are availabe for public view
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Abstract
Immune thrombocytopenic purpura (ITP) is an autoimmune thrombocytopenic syndrome characterized by decreased platelet count and increased risk of bleeding. Conventionally the pathogenesis of ITP is primarily due to immunoglobulins G (IgG) autoantibodies opsonizing the individual’s platelets ,resulting in markedly enhanced Fc receptors (FcR)-mediated phagocytosis and destruction by macrophages in the reticuloendothelial system within spleen. Additionally, T cell-mediated peripheral platelet destruction and megakaryocyte destruction/inhibition in the bone marrow has been shown lead to thrombocytopenia. Corticosteroids are recommended as the first-line therapeutic strategy in practical guidelinePrednisone : Prednisone is usually given at 0.5 to 2mg/kg until platelet count increase (30-50 *10^9/L) which may require several days to several weeks. Although the treatment is effective, patients at risk developing corticosteroid –related complications .To avoid corticosteroid-related complications, prednisone should be rapidly tapered and usually stopped in responders, and especially in non-responders after 4 weeks. Pulsed Dexamethasone: One of first-line in treatment ITP suggesting both a initial response rate and a substantial sustained response rate. Administration of dexamethazone40mg/day for 4days (equivalent to~400mg of prednisone per day)achieved 85% initial response and sustained response 50%of adult cases of ITP at 6 months follow up. Aim of workTo compare between the efficacy and safety of high dose dexamethasone (HD-DXM) and prednisone (PDN) as first line strategies for cases of severe ITP Patients and methods; Prospective observational studyInclusion Criteria: Patients more than 18 years old age diagnosed as primary acute severe ITP presented with active bleeding for emergency treatment. Exclusion Criteria: Patients with hemostatic disorders, malignancy, connective tissue diseases, seropositive detection of HIV, HCV, HBV. Any contraindications for steroid therapy (osteoprosis, uncontrolled diabetes or uncontrolled hypertension). All patients will be subjected to: Full history taking. Full clinical examination. Laboratory investigations: Complete blood countProthrombin time and prothrombin concentrationActivated partial thromboplastin time (Aptt) Kidney function testLiver function testAntinuclear antibody (ANA) Hepatitis markersBone marrow aspirate (if indicated) Abdominal ultrasonography. The results of our work showed that: Both groups had insignificant differences as regarding age, sex, residence, occupation, smoking, phase and previous history of severe ITP It was noticed that the most frequent presentation in both groups was skin bleeding followed by mucous membrane bleeding .Visceral bleeding was insignificantly high in PDN group All baseline data had insignificant differences between both groups (P> 0.05). Platelets count in HD-DXM groupThe outcome of therapy in studied groups after one week from initiation the protocols. There were significant differences between both groups where response, complete response and no response occurred in 15 (60%), 8 (32%), and 2 (8%) patients of HD-DXM group and occurred in 13 (52%), 6 (24%), and 6 (24%) patients of PDN group, respectively. Glucose intolerance (40%) and raised blood pressure (28%) were the most frequent adverse events in PDN group followed by GIT distress (20%) and weight gain (12%). As regarding adverse events in HD-DXM group, it was noticed that glucose intolerance, gastrointestinal distress, raised blood pressure and weight gain occurred.