Do the acute platelet responses of patients with immune thrombocytopenic purpura (ITP) to IV anti-D and to IV gammaglobulin predict response to subsequent splenectomy?

The acute platelet response to Intravenous Gammaglobulin (IVIG) has been re ported to predict response to subsequent splenectomy of patients with ITP. The current study was undertaken to determine if the platelet response to I V anti-D (Winrho-SDF) predicts response to subsequent splenectomy. The 61 H IV-uninfected children and adults in this study had taken part in the pre-l icensing studies of IV anti-D and were all those who not only had evaluable platelet responses to IV anti-D but also had undergone splenectomy and had information available describing its 1-year outcome. Results of treatment with IVIG were available in 38 of these 61 patients. Neither response to th e initial infusion of 1V anti-D, nor response to the initial or last IVIG, predicted the response in either children or adults to subsequent splenecto my. However, response to the last anti-D infusion in adults was strongly co rrelated (P = 0.003) to response to subsequent splenectomy as was hemolysis greater than or equal to2.0 gm/dl after IV anti-D (P = 0.03). There was no overall relationship between response to IV anti-D or IVIG, and response t o subsequent splenectomy. However, a good platelet response in adults to th e last 1V anti-D and a hemoglobin decrease greater than or equal to2.0 gm/d l both appeared to predict response to subsequent splenectomy. Am. J. Hemat ol. 67:2733, 2001. (C) 2001 Wiley-Liss, Inc.