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 with 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 from May 1995 to October 1997 were reviewed. Patient data were eligible for analysis if, for the new diagnosis of acute ITP, the patient had received either 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 treatment 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 1.77 +/- 0.74 and 1.49 +/- 1.01 days for the IVIg and anti-D groups, respectively (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 hemolysis. Conclusions: In this retrospective analysis anti-D was as effective as IVIg for the treatment elf acute ITP in children. However, randomized, controlled trials are needed to establish the role of anti-D in the treatment of acute ITP in children.