Standard-dose Intravenous Anti-D Immunoglobulin Versus Intravenous Immunoglobulin in the Treatment of Newly Diagnosed Childhood Primary Immune Thrombocytopenia

Background: We conducted a study to evaluate the efficacy of intravenous (IV) anti-D against IV immunoglobulin (IVIG) in newly diagnosed immune thrombocytopenia (ITP) in children and to identify the clinical characteristics of the children most likely to benefit from one or the other treatment. Procedure: Children (6mo to 14 y) with newly diagnosed ITP and a platelet count < 20,000/mu L were treated either with a single bolus dose of 50 mu g/kg IV anti-D or with 0.8 to 1 g/kg IVIG in a randomized manner. Results: Twenty-five patients, mean age of 6.8 years, were treated either with IV anti-D (n = 10) or with IVIG (n = 15). Both drugs were equally efficient in raising the platelet count above 20,000/mu L at 24 hours posttreatment. Children who presented with bleeding stage 1 or 2 (no mucosal bleeding) responded better to IVIG treatment, in terms of an increase in platelet count at 24 hours posttreatment (P = 0.04). Hemoglobin drop was greater in the anti-D group (P = 0.002). Conclusions: A single bolus dose of 50 mu g/kg of IV anti-D is a safe and effective first-line treatment in newly diagnosed ITP in childhood and mucosal bleeding is a poor prognostic factor for treatment with IVIG.