Standard-dose intravenous anti-D immunoglobulin versus intravenous immunoglobulin in the treatment of newly diagnosed childhood primary immune thrombocytopenia.
Author(s): Papagianni A, Economou M, Tragiannidis A, Karatza E, Tsatra I, Gombakis N, Athanassiadou-Piperopoulou F, Athanasiou-Metaxa M
Affiliation(s): First Pediatric Department of Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece. email@example.com
Publication date & source: 2011-05, J Pediatr Hematol Oncol., 33(4):265-9.
Publication type: Comparative Study; Multicenter Study; Randomized Controlled Trial
BACKGROUND: We conducted a study to evaluate the efficacy of intravenous (IV) anti-D against IV immunoglobulin (IVIG) in newly diagnosed immune thrombocytopenia (ITP) in children and to identify the clinical characteristics of the children most likely to benefit from one or the other treatment. PROCEDURE: Children (6 mo to 14 y) with newly diagnosed ITP and a platelet count <20,000/muL were treated either with a single bolus dose of 50 mug/kg IV anti-D or with 0.8 to 1 g/kg IVIG in a randomized manner. RESULTS: Twenty-five patients, mean age of 6.8 years, were treated either with IV anti-D (n=10) or with IVIG (n=15). Both drugs were equally efficient in raising the platelet count above 20,000/muL at 24 hours posttreatment. Children who presented with bleeding stage 1 or 2 (no mucosal bleeding) responded better to IVIG treatment, in terms of an increase in platelet count at 24 hours posttreatment (P=0.04). Hemoglobin drop was greater in the anti-D group (P=0.002). CONCLUSIONS: A single bolus dose of 50 mug/kg of IV anti-D is a safe and effective first-line treatment in newly diagnosed ITP in childhood and mucosal bleeding is a poor prognostic factor for treatment with IVIG.