Treatment of childhood acute immune thrombocytopenic purpura with anti-D immune globulin or pooled immune globulin

Objective: To evaluate the effectiveness of initial treatment of children w ith acute immune thrombocytopenic purpura (ITP) with anti-D immune globulin (anti-D) or pooled Ige immune globulin (IVIg). Study design: The medical charts of 33 children diagnosed with acute ITP fr om May 1995 to October 1997 were reviewed. Patient data were eligible for a nalysis if, for the new diagnosis of acute ITP, the patient had received ei ther anti-D at 45 to 50 mu g/kg (WinRho SDI NABI) Or IVIg at 0.8 to I g/kg (Gammagard SE, Baxter-Highland). The platelet response time for each treatm ent group was compared by the Mann-Whitney U test. Results: Time to achieve a platelet count greater than or equal to 20 x 10( 9)/L (20,000/mm(3)) was 1.54 +/- 0.51 days in the IVIg group (n = 13) and 1 .26 +/- 0.82 days in the anti-D group (n = 14) (P =.34). Time to achieve a platelet count greater than or equal to 40 x 10(9)/L (10,000/mm(3)) was 1.7 7 +/- 0.74 and 1.49 +/- 1.01 days for the IVIg and anti-D groups, respectiv ely (P =.32). Children given IVIg were hospitalized for 2.1 +/- 0.87 days, whereas those given anti-D were hospitalized for 1.94 +/- 1.08 days. A net decrease in hemoglobin concentration was observed after receipt of IVIg (9. 1 +/- 7.3 g/L [0.91 +/- 0.73 g/dL]) and after anti-D therapy (4.5 +/- 10.3 g/L [0.45 +/- 1.03 g/dL], P =.23). No patient required intervention for hem olysis. Conclusions: In this retrospective analysis anti-D was as effective as IVIg for the treatment elf acute ITP in children. However, randomized, controll ed trials are needed to establish the role of anti-D in the treatment of ac ute ITP in children.