A multicenter study of the treatment of childhood chronic idiopathic thrombocytopenic purpura with anti-D

https://doi.org/10.1016/S0022-3476(10)80001-0Get rights and content

We evaluated the effects of the intravenous administration of anti-D, an immune globulin directed at the D antigen on erythrocytes that is purified from plasma from sensitized persons, on patients with idiopathic thrombocytopenic purpura. To determine the most effective dose, the duration of response, and the side effects of this therapy in children, we performed a multicenter cohort study of escalating doses of intravenously administered anti-D in children aged 1 to 18 years with chronic idiopathic thrombocytopenic purpura, defined as idiopathic thrombocytopenic purpura persisting for more than 6 months with a platelet count of less than 50 × 109 cells/L. Twenty-five Rh-positive children received increasing doses of anti-D as follows: day 1, 25 μg/kg; day 2,25 μg/kg; day 7, 35 μg/kg; day 14, 45 μg/kg; and day 21, 55 μg/kg. Administration of anti-D was stopped after day 21 or when the platelet count rose to >150 × 109 cells/L or the hemoglobin level was 100 gm/L Platelet count was less than 50 × 109 cells/L in all children before treatment. A response was defined as an increase in the platelet count to more than 50 × 109/L and a doubling of the pretreatment platelet count. Of 25 children, 23 (92%) had responses by day 7 of the initial treatment protocol. Eighteen children (72%) had platelet counts >150 × 109 cells/L by day 7 after two doses of anti-D, Median duration of response was 5 weeks (range 1 to 24 weeks). Average drop in hemoglobin level was 13.7 gm/L; in one child (a nonresponder) hemoglobin value fell to less than 100 gm/L. No other untoward side effects were seen, or the 23 children who responded, 21 were retreated with one dose of anti-D when platelet counts returned to baseline values of less than 50 × 109 cells/L: all but three of the children who underwent retreatment showed a response the second time. Sixteen children continued to receive Intermittent anti-D therapy after completion of the study, and all continued to have excellent responses. We conclude that anti-D is a safe, effective, and relatively inexpensive therapy for childhood chronic idiopathic thrombocytopenic purpura.

References (31)

  • GR Buchanan

    Annotation: the non treatment of childhood idiopathic thrombocytopenic purpura

    Eur J Pediatr

    (1987)
  • M Andrew et al.

    Increased platelet destruction in infancy and childhood

    Semin Thromb Hemost

    (1982)
  • T Hara et al.

    High doses of gamma globulin and methylprednisolone therapy for idiopathic thrombocytopenic purpura in children

    Eur J Pediatr

    (1985)
  • CR Suarez et al.

    High-dose steroids in childhood acute idiopathic thrombocytopenia purpura

    Am J Pediatr Hematol Oncol

    (1986)
  • D del Principe et al.

    Phase II trial of methylprednisolone pulse therapy in childhood chronic thrombocytopenia

    Acta Haematol

    (1987)
  • Cited by (83)

    • Passive Monoclonal and Polyclonal Antibody Therapies

      2020, Immunologic Concepts in Transfusion Medicine
    • The Mechanisms of Action of Intravenous Immunoglobulin and Polyclonal Anti-D Immunoglobulin in the Amelioration of Immune Thrombocytopenic Purpura: What Do We Really Know?

      2008, Transfusion Medicine Reviews
      Citation Excerpt :

      Polyclonal anti-D (a type of IVIg) consists of IgG selectively taken from the plasma of RhD− donors immunized to the D antigen. It has been used to treat ITP in both adults and children9,10,98,99 and has also been used to treat HIV-associated thrombocytopenia.12,100 Salama and coworkers8,9 postulated that the success of anti-D in treating ITP was due to competitive inhibition of the MPS by sensitized RBCs.

    • Thrombocytopenia caused by immunologic platelet destruction

      2018, Wintrobe's Clinical Hematology: Fourteenth Edition
    • ITP in childhood: Predictors of disease duration

      2018, Antibody Therapy: Substitution - Immunomodulation - Monoclonal Immunotherapy
    View all citing articles on Scopus

    Supported in part by Rh Pharmaceuticals Inc., Winnipeg, Manitaba, Canada

    View full text