Clinical experience with anti-D in the treatment of idiopathic thrombocytopenic purpura

Abstract

Idiopathic thrombocytopenic purpura (ITP), an autoimmune disease of children and adults, is characterized by low platelet counts and bleeding through mucous membranes. While not uncommon among otherwise healthy adults and children, ITP is a frequent complication of human immunodeficiency virus (HIV) infection. Anti-D is a gamma globulin (IgG) fraction containing a high proportion of antibodies to the Rh0 (D) antigen of the red blood cells. Clinical studies over the past 10 years have shown intravenous anti-D to be a safe and effective treatment for Rh-positive, nonsplenectomized patients with ITP (classic or HIV-related). While it is unlikely that anti-D is a curative treatment for ITP, repeated infusions can be used to maintain the platelet count at a level sufficient to provide adequate hemostasis (>30,000/microL) and may enable patients to postpone or even avoid splenectomy.