INTRAVENOUS CORTICOSTEROIDS VERSUS INTRAVENOUS GAMMA-GLOBULIN IN THE TREATMENT OF ACUTE IMMUNE THROMBOCYTOPENIC PURPURA

Debate continues over the most appropriate treatment for children with acute immune thrombocytopenic purpura (ITP). An institutional review of all admissions for acute ITP between 1986 and 1991 found 61 children treated with intravenous (IV) IgG or IV steroids with a bone marrow aspirate consistent with ITP, an age of 21 years or younger, and an admission platelet count of less-than-or-equal-to 20,000/mm3. The efficacy of these two agents was compared in the described population. A response was defined as achieving a platelet count of greater-than-or-equal-to 50,000/mm3. A significantly greater percentage of patients responded to IV IgG compared to IV steroids during the first 36 hr of therapy; however, by 72 hr of treatment there was no significant difference. The cost of hospitalization was 3 1/2 times greater for the patients responding to IV IgG vs. IV steroids.