INEFFICACY OF INTRAVENOUS IMMUNOGLOBULIN IN PATIENTS WITH LOW-RISK THROMBOTIC THROMBOCYTOPENIC PURPURA/HEMOLYTIC-UREMIC SYNDROME

Objective: To assess the efficacy of intravenous immunoglobulin (IVIG), in comparison with plasma exchange (PE), in the treatment of patients with thrombotic thrombocytopenic purpura/hemolytic-uremic syndrome (TTP/HUS). Design: Prospective, nonrandomized comparative study. Setting: Hematology department in a general hospital. Patients: 17 consecutive adult patients, six of them pregnant, with diagnosis of TTP/HUS. Three had a severity score at diagnosis less-than-or-equal-to 4 and were treated with IVIG and 14 had a severity score of greater-than-or-equal-to 5 and/or were pregnant and received PE. The response was evaluated after 5 days of therapy. Results: Complete remission was obtained in 0/3 cases treated with IVIG and 10/14 (71%) with PE (Fisher's exact test P = 0.05). Three patients died for widespread TTP-HUS, and four had persistent disease. In three of the four resistant patients, complete remission was obtained by further PE but not by further IVIG. The overall remission rate was 76% (13/17). Conclusions: Our study does not confirm the utility of IVIG in the management of TTP-HUS, as suggested by earlier single case reports.