Low dose intravenous immunoglobulin for acute immune thrombocytopenic purpura in children

Acute immune thrombocytopenic purpura (ITP) is a self-limited autoimmune di sorder to platelets. The disease responds well to intravenous immunoglobuli n (IVIG) treatment. We studied the efficacy of tow dose (1 g/kg) IVIG to tr eat acute ITP in children. Of 17 children with ITP and platelet counts < 20 ,000/<mu>l, 13(76%) had rapid platelet count recovery, reaching safe level (> 50,000/mul) within 4 days after 1 g/kg IVIG. Four children needed a seco nd dose. In 5 of 15 patients, platelet counts recovered to normal without r ecurrence, while in 10 patients, platelet counts declined again 2-3 weeks a fter the initial treatment; 6 of whom (40%) needed re-treatment. All but on e patient had complete recovery of the platelet count by 6 months. Adverse effects of low dose IVIG were minimal. We recommend that for childhood ITP, 1 g/kg IVIG should be tried initially. If inadequate response is seen (pla telet count < 30,000/<mu>l) by 48 hours, a second dose is needed.