Intravenous Immunoglobulin Is Effective
Therapy for Acute Idiopathic Thrombocytopenic Purpura
High doses of IVIG and prednisone can produce a
rapid increase in platelet counts in children with
acute ITP and platelet counts under 20,000 (those at
high risk for intracranial hemorrhage).
The rate of platelet count response was
significantly faster in those given treatment, and
most rapid for those given immunoglobulin.
Two patients (NNT=2) would have to be treated with
IVIG compared to no treatment in order to have one
whose platelet count rose above 50,000 in less than
3 days. Three patients (NNT=3) would have to be
treated with IVIG compared to prednisone for the
Summary of Key Evidence
A randomized trial of 53 patients compared
intravenous immune globulin G (IVIG), oral
prednisone, and placebo in the treatment of
Nineteen patients received IVIG at 1 gm/kg daily
for two days, 18 received prednisone at a dose
of 4 mg/kg (tapered over 21 days), and 16
received no therapy. Baseline clinical
characteristics were similar for all three
groups. The administration of drugs was not
Prior to randomization, subjects were stratified
by severity of hemostatic defect. Inclusion
criteria included: age over 6 months and under
18 years; platelet count less than 20,000; a
bone marrow aspirate consistent with ITP; and no
evidence of chronic ITP.
Primary outcomes for the study were: number of
days with a platelet count under 20,000 and the
number of days required to reach a platelet
count over 50,000. Secondary outcomes were the
occurrence of any adverse effect of therapy.
Median duration of severe thrombocytopenia after
treatment was 1 day for IVIG (p<0.001) and 2
days for prednisone (p<0.01) compared to 4 days
for no therapy. Results between the two
treatment groups were not significantly
The median time to reach a platelet count above
50,000 was 2 days for those in the IVIG group
(statistically different than both prednisone
and no therapy)
Seventy-five percent of those treated with IVIG
had some combination of nausea, vomiting,
headache, and fever. The most common adverse
reaction to prednisone was weight gain.
The main reason for treating children with acute
ITP is the prevention of intracranial hemorrhage
(ICH), a complication that occurs in 1% of
affected children. Randomized studies would
require prohibitively large numbers of patients
in order to use this as an outcome of interest.
Given that acute ITP in childhood is usually
self-limited disease, the inclusion of a
no-therapy group in this study is helpful (and
rather unique among other published studies).
Both therapies performed better than no therapy.
Cost and availability of IVIG are important
Blanchette VS, Luke B, Andrew M, et al. A
prospective, randomized trial of high-dose
intravenous immune globulin G therapy, oral
prednisone therapy, and no therapy in childhood
acute immune thrombocytopenic purpura. J
Pediatr 1993; 123:989-95.