RESUMEN
The prognosis of patients with idiopathic thrombocytopenic purpura refractory to corticosteroids and splenectomy (refractory ITP) is poor; these patients present high morbidity from disease and its treatment and have a mortality rate of approximately 16%. A patient is reported with severe bleeding symptoms related to refractory ITP successfully treated with melatonin.
Asunto(s)
Adyuvantes Inmunológicos/uso terapéutico , Melatonina/uso terapéutico , Púrpura Trombocitopénica Idiopática/tratamiento farmacológico , Quimioterapia Combinada , Equimosis/etiología , Epistaxis/etiología , Humanos , Inmunosupresores/uso terapéutico , Púrpura/etiología , Púrpura Trombocitopénica Idiopática/complicaciones , Púrpura Trombocitopénica Idiopática/cirugía , Índice de Severidad de la Enfermedad , Esplenectomía , Factores de Tiempo , Resultado del TratamientoRESUMEN
In addition to its well-known influence on circadian rhythms, melatonin has been described as being able to increase the number of platelets in circulating blood. This provided the rationale to evaluate melatonin for toxicity and efficacy in three patients with idiopathic thrombocytopenic purpura (ITP) refractory to initial treatment with corticosteroids or splenectomy (refractory ITP). Patients received melatonin for 1 month. The therapy was continued for 2 additional months in patients with stable or responding disease. After 3 months, the stable or responding patients continued the therapy for 3 months and more. All patients had a partial response after 1 month. Continuing with the treatment, none of the three patients had disease progression (average follow-up time of 31 months; range: 23-46 months). Toxicity was lacking, with the only side effect being drowsiness. Our experience suggests that melatonin may be safe and effective in patients with refractory ITP.