Intravenous immunoglobulins ameliorate thrombin-related platelet functions in childhood immune thrombocytopenia

Childhood immune thrombocytopenia (ITP) is an acquired haematological disorder characterized by low platelet counts, with a disease course which is usually benign and self-limiting within 3-12 months. An estimated 28%, however, continue to develop chronic ITP and may experience bleeding symptoms and an impaired quality of life. Treatment options in case of severe bleedings include corticosteroids, anti-D or intravenous immunoglobulins (IVIg). The general working mechanism of IVIg remains unresolved and a matter of debate. Schmugge et al now identify that IVIg may have the ability to improve thrombin-induced platelet activation and enhance thrombin generation in a prospective study of 23 children with primary ITP, demonstrating that besides increasing platelet counts IVIg can be efficacious on the level of thrombin-induced platelet activation and coagulation support. Commentary on: Schmugge et al. IVIg treatment increases thrombin activation of platelets and thrombin generation in paediatric patients with immune thrombocytopenia. Br J Haematol 2023;201:1209-1219.