ANTI-D TREATMENT FOR CHRONIC IMMUNE THROMBOCYTOPENIC PURPURA - CLINICAL AND LABORATORY ASPECTS

We used low-dose anti-D immunoglobulins for home treatment of Rh+ adul t patients with chronic immune thrombocytopenic purpura (ITP). After i nformed consent, 15 unselected outpatients (ten males and five females , aged 22 to 72), affected by chronic ITP with negative HIV test, were given intramuscular injection of 900-1500 mu g of anti-Rh0 (D) IgG ov er 3 days every month for 2 or 3 consecutive months. Platelet count (m ean +/- SD) significantly increased from basal value of 17,000 +/- 9,0 00/mu L to 72,000 +/- 55,000/mu L at the end of treatment. Eight patie nts achieved a rise in platelet count above 50,000/mu L (five above 10 0,000/mu L) and two of them maintained the increase longer than 6 mont hs without further anti-D administration. Three patients responsive to the first cycle responded to further treatment with substantially ide ntical results. Seven patients had no response. Four of them had not r esponded to previous glucocorticoid and intravenous IgG therapy. Direc t antiglobulin test became strongly positive in all patients and mean serum haptoglobin decreased from a basal value of 118 +/- 59 to 61 +/- 43 mg/dL; nevertheless no clinically overt hemolysis was observed in any patient, there was no rise of serum indirect bilirubin and hemoglo bin level was unchanged (mean +/- SD basal level 13.6 +/- 2.2 g/dL; af ter anti-D 13.9 +/- 1.2 g/dL). No hematoma developed at the injection sire, and no other side effects occurred. Our results show that anti-D therapy is effective in the majority of patients well tolerated, and feasible as home treatment: thus it can be recommended as a cheap and safe alternative treatment in ITP Rh+ patients. (C) 1998 Elsevier, Par is.