Efficacy of low dose dexamethasone in severe thrombocytopenia caused by dengue fever: a placebo controlled study

Background: The use of corticosteroids in the management of thrombocytopenia in dengue fever remains untested. Objectives: To test whether intravenous low dose dexamethasone is efficacious in increasing platelet count in acute severe thrombocytopenia in dengue infection. Methods: We undertook a placebo controlled study at the Teaching Hospital, Peradeniya, Sri Lanka in July 2004. Patients with thrombocytopenia (platelet count <50x10(9)/l) were allocated to the treatment and placebo groups using the sealed envelop method. The treatment group received an initial intravenous dose of 4 mg dexamethasone, followed by 2 mg doses every 8 h for 24 h, and the placebo group received normal saline. The primary outcome was the degree of mean platelet count rise. Results: Each group comprised 100 patients and their baseline data and other variables (headaches, nausea, flush, temperature, pulse, blood pressure, haematocrit, white cell count and haemoglobin) were similar. The primary outcome-mean platelet count (x10(9)/l)-increased steadily in both groups from day 1 to 4 and showed no significant difference between the two groups (p > 0.05): day 1, 35 vs 35 (p = 0.70); day 2, 47 vs 43 (p = 0.19); day 3, 64 vs 59 (p = 0.31); day 4, 72 vs 78 (p = 0.55). Analysis of variance (ANOVA) statistics showed a significant linear association of mean platelet counts by days in either group (p < 0.001). Regression analysis identified the day of the illness and patient age as the independent predictors of platelet count change. Conclusion: At a low dose regimen, dexamethasone was not effective in achieving a higher rise of platelet count in dengue infection.