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).


METHODS
Prospective, nonrandomized comparative study.


METHODS
Hematology department in a general hospital.


METHODS
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.
Finazzi
G
G
Hematology Division and Transfusion Department, Ospedali Riuniti, Bergamo, Italy.
Bellavita
P
P
Falanga
A
A
Viero
P
P
Barbui
T
T
D000328:Adult; D000368:Aged; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy / Q000453:epidemiology; D011446:Prospective Studies; D011697:Purpura, Thrombotic Thrombocytopenic / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology
D016756:Immunoglobulins, Intravenous