Comparison of low-dose versus conventional-dose prednisolone in the treatment of Idiopathic Thrombocytopenic Purpura [ITP]

Objective: To assess the efficacy of low-dose prednisolone in patients with ITP

Design: A Prospective Randomized Controlled Trial

Setting: Salmaniya Medical Complex, Kingdom of Bahrain

Method: A randomized controlled trial was conducted comparing the conventional-dose to a lowdose of prednisolone [0.25 mg/kg/day]. Forty-one patients with ITP were enrolled in the study; 21 patients were randomized to low-dose prednisolone [group I] and 20 patients received the conventional-dose [group II]

Result: The overall remission rate [OR] for both groups was 78.05%. There was no statistically significant difference between both groups in terms of group overall remission 17 [81%] versus 15 [75%], group complete remission 11 [52.4%] versus 10 [50%] or partial remission rate 6 [28.6%] versus 6 [25%]. In addition, failure rate, relapse rate, and splenectomy rate were similar and not statistically significant. Two [10%] patients developed complications related to steroids therapy, both were in group II, but were not statistically significant

Conclusion: Although the study had a small number of patients, it revealed that low-dose of prednisolone [0.25 mg/kg/day] is as effective as the conventional-dose [1 mg/kg/day] and probably, safer. Accordingly, we recommend the use of low-dose prednisolone as initial therapy for ITP rather than the high-dose

Transfusion-related acute lung injury [TRALI] and strategies for prevention

Transfusion-Related Acute Lung Injury [TRALI] is a serious complication of blood transfusion. In recent years, TRALI has been reliably shown to be the most common cause of transfusion-related fatalities in the United States and in the United Kingdom. Its prevalence is about 1 in 1323 transfused components; however, it is often under diagnosed. Classically, TRALI present as non- cardiogenic pulmonary oedema. Management is mainly supportive with 72% of cases requiring ventilatory support. The aim of the study was to highlight the condition, discuss the pathophysiology of the disease and the preventive measures. Retrospective study. Haematology/Oncology department, Salmaniya Medical Complex, Kingdom of Bahrain. Two patients with documented and proven TRALI were encountered at our department from January 2004 till end of December 2006. The records of these patients were reviewed for personal characteristics, clinical settings, the components transfused, time onset of the complication, and management and outcome. Two female patients were found, one 20 years old, was transfused 2 units of packed red blood cells [PRBC] because of low haemoglobin, she developed [TRALI] during the transfusion. The second case was 38 years old lady; she developed [TRALI] two hours following platelets transfusion for thrombocytopenia. Both were managed conservatively. TRALI is a rare and serious disease, however, we reported two critical cases to raise the awareness of the problem and build a high index of suspicion for these cases especially where the practice of transfusion is common. We also propose some recommendations for prevention