title: Low-dose versus high-dose immunoglobulin for primary treatment of acute immune thrombocytopenic purpura in children: results of a prospective, randomized single-center trial.
abstract: OBJECTIVE
  To investigate the efficacy and side effects of two different intravenous immunoglobulin (IVIG) dose regimens for the initial treatment of childhood acute immune thrombocytopenic purpura (ITP).
  
  
  METHODS
  Thirty-four consecutive patients with a clinical diagnosis of acute ITP and a platelet count below 20x10(9)/L were randomized to receive either 1 g/kg body weight (n=17; group A) or 0.3 g/kg body weight (n=17; group B) IVIG per day for 2 consecutive days (total dose 2 g/kg and 0.6 g/kg).
  
  
  RESULTS
  Fifteen of the 17 patients (88.2%) in group A and 13 of the 17 patients (76.5%) in group B achieved a platelet count of more than 20x10(9)/L within 72 hours. The increase in platelet counts on day 2 and 3 was more pronounced in the high-dose group. Two patients in the high-dose group and four in the low-dose group were non-responders. Chronic disease occurred in three patients receiving 2 g/kg IVIG and in five patients receiving 0.6 g/kg IVIG. Side effects of IVIG administration were more common in the high-dose group.
  
  
  CONCLUSIONS
  The present study showed that platelet counts increased more rapidly after high-dose IVIG administration within the first 72 hours, although a platelet count of more than 20x10(9)/L can be achieved also with low-dose IVIG in most children with acute ITP. For patients with very low platelet counts, doses higher than 0.6 g/kg seem, therefore, to be more effective.
authors.affiliation: Department of Pediatrics and Adolescent Medicine, University of Graz, Austria. martin.benesch@klinikum-graz.at
authors.forename: Martin
authors.initials: M
authors.lastname: Benesch
authors.forename: Reinhold
authors.initials: R
authors.lastname: Kerbl
authors.forename: Herwig
authors.initials: H
authors.lastname: Lackner
authors.forename: Andrea
authors.initials: A
authors.lastname: Berghold
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schwinger
authors.forename: Karin
authors.initials: K
authors.lastname: Triebl-Roth
authors.forename: Christian
authors.initials: C
authors.lastname: Urban
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001792:Blood Platelets / Q000166:cytology / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D007167:Immunotherapy; D007223:Infant; D008297:Male; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy* / Q000276:immunology* / Q000473:pathology; D011897:Random Allocation; D012008:Recurrence
chemical_list: D016756:Immunoglobulins, Intravenous