From the Guidelines
The recommended dose of Intravenous Immunoglobulin (IVIG) for Immune Thrombocytopenic Purpura (ITP) is 1 g/kg as a one-time dose, which may be repeated if necessary. This dose is based on the most recent and highest quality study available, which suggests that IVIG can be used with corticosteroids when a more rapid increase in platelet count is required 1. The use of IVIG in ITP is supported by guidelines from the American Society of Hematology, which recommend IVIG as a first-line treatment option in certain cases, such as when corticosteroids are contraindicated or when a rapid increase in platelet count is needed 1.
Some key points to consider when using IVIG for ITP include:
- The effect of IVIG is temporary, usually lasting 2-4 weeks
- IVIG works by blocking Fc receptors on macrophages, preventing the destruction of antibody-coated platelets
- Common side effects include headache, fever, chills, myalgia, and nausea
- Premedication with acetaminophen and diphenhydramine can help reduce infusion reactions
- For patients with renal impairment, cardiac disease, or those at risk for thrombosis, the dose may need adjustment and slower infusion rates may be required
It's worth noting that the 2018 study 1 provides more recent guidance on the use of IVIG in ITP, and its recommendations are consistent with those of the 2011 study 1. Therefore, the dose of 1 g/kg as a one-time dose, which may be repeated if necessary, is the most appropriate recommendation based on the available evidence.
From the Research
Dose of Intravenous Immunoglobulin (IVIG) for Immune Thrombocytopenic Purpura (ITP)
The dose of IVIG for ITP varies, with different studies suggesting the following:
- 250 mg/kg/day, 400 mg/kg/day, or 500 mg/kg/day for 2 days, as shown to be effective in infants and young children with ITP 2
- 400 mg/kg/day for two to five days, as recommended for the treatment of ITP 3
- 0.4 g/kg daily for 2 to 5 consecutive days, as approved for the treatment of ITP 4
- 1 g/kg body weight per day for 2 consecutive days (total dose 2 g/kg), as compared to 0.3 g/kg body weight per day for 2 consecutive days (total dose 0.6 g/kg) in a prospective, randomized single-center trial 5
- 2 g/kg totally, as compared to single doses of anti-D immunoglobulin at 50 μg/kg and 75 μg/kg in newly diagnosed children with ITP 6
Key Findings
- Low-dose IVIG regimens (250,400, or 500 mg/kg/day for 2 days) are safe and well-tolerated in infants and young children with ITP 2
- The incidence of adverse events (AEs) is lower in children younger than 5 years of age 2
- High-dose IVIG administration (1 g/kg body weight per day for 2 consecutive days) may be more effective for patients with very low platelet counts 5
- IVIG is well tolerated and significantly more effective than standard and high-dose anti-D IVIG for the treatment of newly diagnosed ITP in children 6