Single dose of anti-D immune globulin at 75μg/kg is as effective as intravenous immune globulin at rapidly raising the platelet count in newly diagnosed immune thrombocytopenic purpura in children

Objective

To conduct a randomized prospective trial of immune globulin treatment for 105 Rh+ children with newly-diagnosed immune thrombocytopenic purpura and a platelet count < 20,000/μL, to determine whether anti-D immune globulin (anti-D) is as effective as intravenous immune globulin (IVIg).

Study design

Eligible patients received either a single intravenous dose of 50 μg/kg anti-D (anti-D50), 75 μg/kg anti-D, (anti-D75), or 0.8 g/kg IVIg, (IVIg). Patients were monitored for response to treatment and adverse events.

Results

By 24 hours after treatment 50%, 72%, and 77% of patients in the anti-D50, anti-D75, and IVIg groups, respectively, had achieved a platelet count >20,000/μL (P = .03). By day 7, hemoglobin concentrations decreased by 1.6 g/dL, 2 g/dL, and 0.3 g/dL in the anti-D50, anti-D75, and IVIg groups, respectively. Headache, fever, or chills occurred least often in the anti-D50 group.

Conclusions

A single 75μg/kg dose of Anti-D raised the platelet count in children with newly diagnosed immune thrombocytopenic purpura more rapidly than standard-dose anti-D and as effectively as IVIg, with an acceptable safety profile.

Abbreviations: anti-D, Anti-D immune globulin, CBC, Complete blood count, ICH, Intracranial hemorrhage, ITP, Immune throbocytopenic pupura, IVIg, Intravenous immune globulin, Rh, Rhesus antigen, Rh+, Rhesus antigen positive, Rh-, Rhesus antigen negative