Dr. Mubashir Razzaq Khan
Hematology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 36-year-old female. I was recently diagnosed with ITP with platelets between 23 to 33 eight months ago, with symptoms of gum bleeding and knee joint pains but no bruises. I am taking 5 mg Prednisolone, with which my platelets became 65 to 71 last month. I have a history of congenital heart disease ASD with mild pulmonary hypertension and childhood epilepsy. I am taking a multivitamin and hemoglobin tablets. My concern is taking Rituximab to resolve my issue, even with my heart condition.
Regards.
Hi,
Welcome to icliniq.com.
Your current platelets, that is, 65, are quite a handsome level in ITP (immune thrombocytopenia). We call it chronic ITP. At this point, we do not treat ITP. You are taking 5 mg per day of Prednisolone which is called a maintenance dose. In my practice, I prescribe Rituximab to only refractory patients (platelets less than 25 despite all treatment) with symptoms of bleeding. Nonetheless, you can take Rituximab with the data you provided here. Your heart condition is not very serious. Do write back if anything is not clear.
Regards.
Patient's Query
Hi doctor,
Thanks for your reply.
From your experience, is it safe to continue using the 5 mg steroids daily until I am ready to do the Rituximab treatment? Or should I stop it due to the risks of prolonged use, like diabetes, osteoporosis, etc.? I do not want to do the treatment right away because my platelets are above 50.
Regards.
Hi,
Welcome back to icliniq.com.
5 mg daily is too low a dose to cause serious side effects. So you can continue with it. It is called the maintenance dose. You can take it for a year or more.
Regards.
Patient's Query
Hi doctor,
Thank you for the reply.
Ok, thanks. I have one more question. I understand that there is another first-line treatment called IVIG before considering Rituximab. When will you need that, and in my case, is it not the next step for me before Rituximab is considered?
Thank you.
Hi,
Welcome back to icliniq.com.
IVIG (intravenous immunoglobulin) is a temporary first-line treatment. It masks all the antibodies separating in the blood; later on, the production of antibodies is continued that destroys platelets after a couple of weeks. So it is not a curative treatment. It is just a sportive treatment to raise the platelet counts temporarily; line treatment is with steroids. Rituximab does have a role in destroying the CD 20 (cluster of differentiate 20) positive lymphocytes, which produce antibodies. But in many patients, Rituximab does not prove to be helpful. So as far as your condition is concerned, you do not need any aggressive or expensive treatment with a platelet count above 50.
Regards.
Patient's Query
Hi doctor,
Thank you so much again for your help.
It was something I was not too clear with. I appreciate it. Take care.
Hi,
Welcome back to icliniq.com.
Thank you.
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