Anti-D immunoglobulin versus immunoglobulin G for the treatment of acute immune thrombocytopenia in children: a 10-year retrospective study

BackgroundAnti-D immunoglobulin (anti-D) therapy is cheaper and has a shorter infusion time than intravenous immunoglobulin G (IgG), but their comparative effects in the treatment of acute immune thrombocytopenia (ITP) have not been studied thoroughly. The aim of this study was to compare the effect of anti-D and intravenous IgG in the treatment of acute ITP in children.MethodsThe medical records of children diagnosed with acute ITP between January, 2008, and January, 2018, at Al-Rantisy Specialized Pediatric Hospital (a tertiary care centre) in Gaza were reviewed. Patients who received either intravenous anti-D (75 μg/kg, single dose) or intravenous IgG (2 g/kg, divided doses) as initial treatment for ITP were included in this retrospective study. Data on patient demographics, hospital stay period, and adverse drug reactions were collected for analysis. Laboratory results, including platelet counts and haemoglobin levels, were evaluated before treatment, and after 1, 3, 5, and 7 days of treatment. The therapy response was defined as the time taken to increase the platelet count to at least 20,000 platelets per μL.FindingsData from 134 patients (mean age, 5·8 years; range, 1·1–10·4 years) were included for analysis. 32% of patients (43 of 134) received anti-D and 68% of patients (91) received intravenous IgG. Mean pre-treatment platelet counts were 6420 platelets per μL and 8750 platelets per μL for anti-D and intravenous IgG groups, respectively. The platelet count increased significantly after 1, 3, 5, and 7 days of treatment in both groups (p<0·001). After 24 h of treatment, 58% of patients (25 of 43) in the anti-D group and 55% of patients (50 of 91) in the intravenous IgG group had platelet counts of over 20 000 platelets per μL. Moreover, all of the patients in both groups had more than 20 000 platelets per μL after 7 days of therapy. There were no significant differences in platelet count after treatment between the two groups. Haemoglobin levels decreased during the 72 h after treatment (anti-D group, mean 0·8 g/dL, range, 0·1–1·4 g/dL; intravenous IgG group, mean 0·5 g/dL, range, 0·2–1·2 g/dL; p=0·237), but increased on days 5 and 7 in both groups. The changes in haemoglobin after treatment were similar in both study groups. No patient developed severe anaemia requiring medical intervention. The average length of hospital stay was significantly shorter in the anti-D group than in the intravenous IgG group (1·8 days and 3·2 days, respectively; p<0·0001). Fewer adverse effects (headache, vomiting, chills) were reported in children who received anti-D therapy.InterpretationIn this analysis, anti-D was as effective as intravenous IgG in the treatment of children with acute ITP. Given that patients in the anti-D group experienced fewer adverse effects and shorter hospitalisation times than patients in the intravenous IgG group, this suggests that anti-D is a good substitute for intravenous IgG in the treatment of children with acute ITP.FundingNone.