Intravenous immunoglobulin G and anti-D as therapeutic interventions in immune thrombocytopenic purpura.
Immune thrombocytopenic purpura (ITP) is a disorder caused by accelerated destruction of antibody-coated platelets in the reticuloendothelial system (RES), especially the spleen. Inhibition of RES function following intravenous administration of high-dose immunoglobulin G (IVIG) or intravenous anti-D leads to rapid, albeit usually temporary, reversal of thrombocytopenia in the majority of children and adults with ITP. In emergency situations high-dose IVIG is preferred over anti-D because of the more rapid rate of platelet response; for maintenance therapy in Rh positive ITP patients (e.g. children with chronic ITP pre-splenectomy) anti-D is preferred because of its comparable efficacy to IVIG plus ease of administration and lower cost. In children with typical acute ITP and platelet counts < 20 x 10(9)/L IVIG is preferred over anti-D; however other approaches in this patient cohort should be considered before high-dose IVIG, specifically careful observation alone with therapy given only to children with clinically significant haemorrhage or short course oral prednisone at a starting dose of approximately 4 mg/kg/day. Studies are required to define the short and longer term effects of both IVIG and anti-D on the immune system in order to plan more rational use of these immunomodulatory therapies in this model autoimmune disorder.
Blanchette
V
V
Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada. victor.blanchette@sickkids.on.ca
Carcao
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M
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001327:Autoimmune Diseases / Q000276:immunology / Q000628:therapy*; D002648:Child; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007112:Immunity, Maternally-Acquired; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007231:Infant, Newborn; D007518:Isoantibodies / Q000627:therapeutic use*; D010976:Platelet Count; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000276:immunology / Q000628:therapy*; D018029:Rho(D) Immune Globulin; D013103:Spherocytosis, Hereditary / Q000276:immunology
D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D007518:Isoantibodies; C061961:RHO(D) antibody; D018029:Rho(D) Immune Globulin