Chronic idiopathic thrombocytopenia treated with immunoglobulin

SUMMARY Twenty five children with chronic idiopathic thrombocytopenic purpura followed from 6-96 months in 7 Italian paediatric departments were treated with high dose immunoglobulin according to a multicentre protocol. Positive responses were observed in 20 of 25 patients (80%) and negative responses in 5 of 25 (20 %). On previous steroid treatment 7 of 10 positive responders were steroid resistant and 13 of 15 were steroid dependent. Within four weeks of beginning treatment 16 of 20 patients (80%) relapsed, while 4 of 20 (20%) maintained normal platelet values after 4-12 months ' follow up. Statistical analysis of the platelet count on day five of treatment enabled us to divide positive responders into three groups: good, intermediate, and poor. The possible mode of action and clinical application of high dose immunoglobulin are discussed. In 1977 Grassi and Brogi, ' and more recently other authors,2-10 have shown that immunoglobulin treatment has some effectiveness in idiopathic thrombocytopenic purpura (ITP). In these studies criteria for patient selection (age, acute or chronic phase of disease) and treatment regimens differed. From these trials it emerges that the efficacy of immunoglobulin treatment depends on an intact Fc fragment that reacts with the macrophage Fc receptor.5 This multicentre study was undertaken by the Haemostasis Study Group of the Italian Association of Paediatric Haematology and Oncology and by th