The Battle with Prednisone
A few days back, I shared the details of my daughter's journey with ITP. One of the reasons I thought it would be interesting to share all this was because of how young she was as this all started to unfold (5 months of age). It's not very common for this to occur at this age. I hope you all can learn a thing or two for your patients.
I last left off letting you know we were waiting for the bone biopsy results. Well, those all came back negative. This means our little girl has healthy bone marrow and is producing all three cell lines as she should. This further aligns with the diagnosis of ITP, as it's mainly a diagnosis of exclusion.
As discussed in the previous email, she had an elevated immature platelet fraction, which correlates with the biopsy result. If she were to have bone marrow failure, then her IPF would be normal/low. This lab was incredibly reassuring to have even before the biopsy was done.
So, now that we have officially excluded leukemia, we can start her on steroids to bump her platelets. Remember, steroids don't cure ITP. It's just a way to increase the platelets (momentarily).
Because she's had this for 3 months now, the hope is that the steroids increase the platelets enough so that she's making more than her body consumes. Most pediatric patients will recover between 3-6 months (with or without medication). But, 10-20% will develop chronic ITP (thrombocytopenia >12 months).
We chose to start meds now because she's 9 months. I don't know if you have kids, but this is about the age where sitting still becomes incredibly boring, lol! She wants to move, and we don't want to restrict her as she develops.
Now, there are two main options we can go with: prednisone or dexamethasone.
Our hematologist decided to go with a 7-day course of prednisone vs. dexamethasone. Her reasoning was because:
Our daughter is young
There's a higher risk of suppressing the hypothalamic-pituitary-adrenal axis with dexamethasone
From my reading, platelets start to decrease when prednisone is stopped (in most). On the flip side, dexamethasone might keep the platelets elevated for an additional 3-4 weeks following the last dose (for the most part).
As you can see, both medications have pros and cons (and nothing is a hard and fast rule for either). The plan is to recheck platelet levels one week after the last dose of prednisone.
We'll start the first dose tomorrow as we had zero luck getting her to keep down 7.5 ml; it's pretty nasty stuff for those who've never tried it.
Because she threw up the entire dose, I asked the doc to resend a prescription in pill form so we could crush and mix. This looks a lot more feasible. But we'll find out tomorrow...wish us luck!