Place of intravenous immunoglobulin in autoimmune thrombocytopenic purpura

Severe autoimmune thrombocytopenic purpura is now commonly treated with high doses of intravenous immunoglobulins. Twenty-four years after this treatment was first shown to be effective, several questions remain to be resolved. We review here current knowledge concerning the frequency and type of side effects and the likely mechanism of action of intravenous immunoglobulins. We suggest that the currently recommended dose of intravenous immunoglobulins (2 g per kg body weight) could be halved, that the total dose of intravenous immunoglobulins should be administered as a single infusion, that non responders could be given another equal dose on day three, and that intravenous immunoglobulins plus prednisolone should be considered the gold standard for treatment of the most severe forms of the disease. Treatment with anti-D immunoglobulin could be proposed as an alternative if the results recently obtained with high doses (75 lg per kg body weight) are confirmed. Finally, as intravenous immunoglobulins have only a transient effect, they cannot be considered a curative treatment for patients with chronic autoimmune thrombocytopenic purpura.