COMPATIBILITY AND EFFICACY OF 5-PERCENT V ERSUS 10-PERCENT INTRAVENOUS IMMUNOGLOBULIN SOLUTIONS IN ADULT PATIENTS WITH IMMUNOTHROMBOCYTOPENIA - A PILOT-STUDY

Very low platelet counts in autoimmune thrombocytopenia cause a bleedi ng tendency that may result in lethal intracerebral hemorrhage in 2-10 % of adult patients. Fast but transient recovery of platelet counts ma y be achieved with application of i. v. immunoglobulins in a dosage of 1 g/kg body weight on 2 consecutive days. A reduction of the fluid vo lume in this setting may be beneficial for elderly patients and also r educes the time needed for infusion. In a pilot study on 12 patients w ith autoimmune thrombocytopenia, we thus compared safety and efficacy of a new 10% i.v. immunoglobulin preparation with a standard 5% prepar ation (Bayer AG, Biologische Praparate, Leverkusen, Deutschland). Pati ents with newly diagnosed or recurrent autoimmune thrombocytopenia wer e randomized between the two treatment arms if they had platelet count s below 20 x 10(9)/l or clinically manifest bleeding. Twelve patients (2 male, 10 female) aged between 25 and 86 years were treated either w ith the 5% or the 10% ivIgG preparation. Eight patients had recurrent thrombocytopenia and 6 patients had been pretreated with corticosteroi ds. Signs of bleeding and complete blood counts were determined on day s 1 to 7, and on day 14. Body temperature and potential side effects w ere monitored every 10 min during the infusion. 48 h after the start o f infusion, all patients had platelet counts of > 50 x 10(9)/l and no more bleeding symptoms. There was no difference in efficacy or toleran ce between the two preparations. In each group there was one minor sid e effect (headache or nausea) on the 2nd day of treatment. The time ne eded for infusion was reduced by 17% in patients treated with the 10% IgG preparation, and infusion volume was halved. From this pilot study we conclude that both 5% and 10% immunoglobulin preparations are effe ctive and equally well tolerated in the treatment of autoimmune thromb ocytopenia in adults.