Low dose intravenous immunoglobulin for acute immune thrombocytopenic purpura in children.

ABSTRACT

Acute immune thrombocytopenic purpura (ITP) is a self-limited autoimmune disorder to platelets. The disease responds well to intravenous immunoglobulin (IVIG) treatment. We studied the efficacy of low dose (1 g/kg) IVIG to treat acute ITP in children. Of 17 children with ITP and platelet counts < 20,000/microl, 13 (76%) had rapid platelet count recovery, reaching safe level (> 50,000/microl) within 4 days after 1 g/kg IVIG. Four children needed a second dose. In 5 of 15 patients, platelet counts recovered to normal without recurrence, while in 10 patients, platelet counts declined again 2-3 weeks after the initial treatment; 6 of whom (40%) needed re-treatment. All but one patient had complete recovery of the platelet count by 6 months. Adverse effects of low dose IVIG were minimal. We recommend that for childhood ITP, 1 g/kg IVIG should be tried initially. If inadequate response is seen (platelet count < 30,000/microl) by 48 hours, a second dose is needed.