Intravenous immunoglobulin therapy of immune thrombocytopenia.

ABSTRACT

High dose intravenous gamma globulin has been used in the therapy of immune thrombocytopenia with variable success. Nine non-splenectomized patients with immune thrombocytopenia (8 ITP, 1 Evans syndrome) were treated with IV IgG. One patient with ITP and the case of Evans syndrome had chronic disease, and the others had acute ITP. All patients had been pretreated with steroids with variable response. The patient with chronic ITP and the one with Evans syndrome responded completely to IgG; remission has lasted for 18 months in both. Two patients with acute ITP responded fully to IgG, but one relapsed after 8 months and the other was lost to follow-up after 1 month. Two patients with acute ITP had partial response to IgG, which could be maintained off steroids in one and on a low dose of steroids in the other. Three patients with acute ITP had no response at all to IgG. High dose IV IgG is useful in selected cases of acute as well as chronic ITP, and previous response to steroids increases the likelihood of response. Splenectomy is not a prerequisite for response.