HIGH-DOSE INTRAVENOUS IMMUNE GLOBULIN AND THE RESPONSE TO SPLENECTOMYIN PATIENTS WITH IDIOPATHIC THROMBOCYTOPENIC PURPURA

Background High-dose intravenous immune globulin produces a temporary rise in the platelet count in patients with idiopathic thrombocytopeni c purpura. Splenectomy may also be effective, but it is not possible t o predict which patients will have a good response. We hypothesized th at the response to intravenous immune globulin predicts the response t o splenectomy. Methods We studied retrospectively 30 patients with idi opathic thrombocytopenic purpura who had first been treated with immun e globulin and then undergone splenectomy. The responses to the two tr eatments were classified on the basis of the platelet count as poor (< 50,000 per cubic millimeter), good (50,000 to 150,000 per cubic milli meter), or excellent (> 150,000 per cubic millimeter). Results All nin e patients who had poor responses to intravenous immune globulin also had poor responses to splenectomy at one year. Of the 21 patients with good or excellent responses to intravenous immune globulin, 19 had go od or excellent responses to splenectomy. Conclusions Patients with id iopathic thrombocytopenic purpura who have good or excellent responses to intravenous immune globulin are likely to have good or excellent r esponses to splenectomy, whereas patients who have poor responses to i ntravenous immune globulin are unlikely to have good or excellent resp onses to splenectomy. (C) 1997, Massachusetts Medical Society.