Hormone reduction precautions for chronic immune thrombocytopenic purpura

  1. If the platelets have been stabilized at 50×10^9/L for at least 8 weeks (2 months) with oral hormone (prednisone, medrol or dexamethasone, etc.) treatment, you can consider gradually reducing the dose by half (1/2) of the total daily oral hormone every 3 weeks; the platelet count should be checked regularly during the dose reduction period, and if the platelet count is lower than 50×10^9/L The reduction should be suspended and the patient should return to the hospital for follow-up.  2. When the daily oral hormone dose is reduced to the following dose, the relevant immune indexes (lymphocyte subpopulation, CD20, T-lymphocyte activation status and regulatory T cells, etc., blood specimens should be sent to the flow cytometry laboratory of our hospital) and platelet-related antibodies should be rechecked at the hospital.  3. If the above immune indicators (lymphocyte subpopulation, CD20, T-lymphocyte activation status and regulatory T cells, etc.) become normal and the platelet-related antibodies have turned negative, continue to reduce the dose every 3 weeks until discontinuation of the drug; if the above indicators are still abnormal (most commonly, there is still an elevated proportion of B-cell subpopulation or a persistent low proportion of regulatory T cells), suspend the dose reduction and use the currently effective If there are still abnormalities in the above indexes (commonly, there is still an elevated B-cell subpopulation ratio or a persistently low regulatory T-cell ratio), the dose reduction should be suspended, and the currently effective low-dose hormone should be maintained orally for 12 weeks (3 months) to 24 weeks (6 months), and the above indexes should be checked again before deciding on the next treatment.  4. Try to take hormones at once in the morning, and avoid using immune boosters (such as interferon, pidomod, foscarnet and Bystolic, etc.) while taking hormones, and avoid immunizations.  5. If you need to prevent and control respiratory infections caused by hormone use, you can use intravenous immunoglobulin (IVIG, gammaglobulin) at 200-300mg/kg intravenous infusion once a month.  6.Avoid the use of immune enhancers (such as interferon, pidomotor, foscarnet and Bystolic, etc.) and immunizations for 1-2 years after hormone discontinuation.