INTRAVENOUS IMMUNOGLOBULIN ANTI-D TREATMENT OF CHRONIC IMMUNE THROMBOCYTOPENIC PURPURA IN CHILDREN

Eleven children with chronic immune thrombocytopenic purpura were trea ted with a 40 mg/kg dose of intravenous immunoglobulin anti-D (WinRho- SD). In 7 patients the results were regarded as very good (the platele t count increased by >100 Y 10(9)/1) and in 2 as good (>50 Y 10(9)/1); in 2 children the increase in platelet count was low (<50 Y 10(9)/1), despite repeated WinRho-SD administration. The increase in platelet c ount was achieved within 3 or 4 days and persisted for 2 to 36 weeks ( median 8). In all patients mild red cell destruction occurred, reflect ed not only in routine tests but also in the elevated number of IgG mo lecules on patients' red cells (enzyme-linked antiglobulin test) and i n their adherence and phagocytosis by patients' monocytes (monocyte mo nolayer assay). Additional observations concerning the interaction bet ween patients' monocytes and donors' erythrocytes sensitized with a kn own amount of anti-D suggest that the mechanism of intravenous immuno- globulin anti-D action is not restricted to Fcg receptor blockade.