[High-dose immunoglobulin infusions in idiopathic thrombopenic purpura]

In childhood approximately 90% of all idiopathic thrombocytopenic purpuras (ITP) are acute while in adults the majority is chronic (6 months duration). 0,5 - 1% of the children with ITP die. Conventional treatment comprises corticosteroids and, for chronic ITP, splenectomy and/or cytostatic immunosuppression. Inspired by the disappearance, during substitution, of concomitant ITP in 2 agammaglobulinemic boys, 13 children with ITP (3 chronic, 4 intermittent, 6 acute) were treated with high-dose intravenous immunoglobulin SRK. All responded favorably but one boy with chronic ITP became resistant after 11 months of infusions. F(ab')2 fragments are inactive. High doses of immunoglobulin could block Fc receptors of macrophages. They could also facilitate the formation and elimination of immune complexes and, indirectly, prevent the accumulation of platelet-associated immunoglobulin.