Anti-D Exerts a Very Early Response in Childhood Acute Idiopathic Thrombocytopenic Purpura

Abstract

Acute idiopathic (immune) thrombocytopenic purpura (ITP) in the pediatric population is a disease in which autoimmune features are mainly self-limited, with a reported mortality of 0.1-0.5%. Major treatment requires intravenous gammaglobulins (i.v. IgG) and corticosteroids. Recently a new globulin, anti-D, has been introduced. The authors have treated 25 children suffering from acute idiopathic thrombocytopenic purpura, with an i.v. anti-D dose of 75 microg/kg as the first treatment. Eligibility criteria included a platelet count < 15,000 and Rh+. Post-treatment response was 76% > 20,000 platelets at 6-10 h and 80% > 50,000 platelets at 48 h; three patients developed chronic idiopathic thrombocytopenic purpura. There were 5/25 patients who did not respond to the initial dose and received i.v. IgG and corticosteroids, 2/5 with a positive response (platelets > 20,000). Side effects consisted of chills (9/25), fever > 38 degrees C (6/25), headache and vomiting (1/25), hemolysis (20/25) from 0.9-6.9 g%, and decrease in hemoglobin levels. One patient needed a blood transfusion after his Hbg decreased from 12.4 to 5.5 g%. The results indicate that anti-D is an effective treatment in acute ITP, but with side effects. Administration of steroids and antipyretics prior to anti-D treatment may prevent the side effects.

Acute Idiopathic Thrombocytopenic Purpura of Childhood-Diagnosis and Therapy

“…43,46,47 The mechanism of action of anti-D is similar to IVIg in that it decreases the clearance of platelets. More specifically, anti-D binds to the Rh + red blood cell and sensitizes it to bind to the macrophage Fc receptor and thereby promotes its clearance by the spleen.…”

“…48 Higher doses of anti-D (50-75 mg/kg) have been shown to be the most effective at increasing the platelet count within 24 to 48 hours similar to IVIg. 46,47,49,50 Anti-D is given IV over 15 to 30 minutes and thus can be easily administered in an outpatient or emergency department setting. It has also been shown to be less costly than an equivalent dose of IVIg.…”

Update on the management of immune thrombocytopenic purpura in children

“…Two prospective randomized trials published since the ASH and BSH guidelines claim comparable efficacy (in producing a rise in platelet count) and at least comparable safety, for standard (50 mg/kg) or higher-dose (75 mg/kg once) anti-D for newly diagnosed [25 ] or chronic [51] ITP in children. In addition, three nonrandomized trials (all level V data) have reported the use of standard and higher-dose anti-D in children with established ITP with efficacy in raising the platelet count presumed [49,57] or shown to be comparable [50] to IVIg treatment. The literature on anti-D use in ITP has been carefully reviewed [58].…”

Immune thrombocytopenia in children with reference to low income countries

“…In high-income countries 75%-90% of cases go into complete remission irrespective of the treatment given [39][40][41] and the reported mortality in ITP is 0.1%-0.5% [23,42]. In low-income countries the remission rate within 6 months is about 44%-100%, irrespective of treatment [11,[19][20][21]43].…”