Intramuscular anti-D immunoglobulins for home treatment of chronic immune thrombocytopenic purpura

To assess the efficacy of home treatment with intramuscular anti-D immunoglobulins (anti-D IgG) in patients with idiopathic or HIV-related chronic immune thrombocytopenic purpura (ITP), we conducted an open label, non-controlled, prospective study with a follow-up of 6 months in 51 consecutive patients with HIV-related (n = 24) or idiopathic ITP (n = 27). Anti-D IgG (13 micrograms/kg) were infused intravenously for three consecutive days (induction therapy). Patients whose platelet counts failed to increase above 50 x 10(9)/l were given a second course of the same therapy. If their platelet counts remained lower than 50 x 10(9)/l, they were considered non-responsive. Patients who responded to induction therapy were injected intramuscularly with 6 micrograms/kg/week anti-D IgG if platelets were between 50 and 100 x 10(9)/l or 13 micrograms/kg/week if they dropped to less than 50 x 10(9)/l. After induction therapy, responses occurred in 20/24 HIV-related chronic ITP patients (83%) and in 14/27 idiopathic chronic ITP patients (52%). During follow-up, platelets remained above 50 x 10(9)/l in 17/20 HIV-related chronic ITP patients (85%) and in 8/14 (57%) idiopathic chronic ITP patients. We conclude that anti-D IgG are a valid therapeutic option for treatment of idiopathic and HIV-related chronic ITP, since they are safe, cheap and can be given intramuscularly at home