Transient Reversal of Thrombocytopenia in Idiopathic Thrombocytopenic Purpura by High-Dose Intravenous Gamma Globulin

Since recent observations indicate that treatment with high-dose intravenous polyvalent intact immunoglobulin leads to a rapid reversal of thrombocytopenia in the idiopathic thrombocytopenic purpura (ITP) of childhood, we decided to apply this treatment to adults with ITP and to test the possibility that the effect of the immunoglobulin might be attributable to transient blockade of the reticuloendothelial system. Using sequential clearance studies of autologous 99m Tc-labeled and anti-Rh(D)-sensitized erythrocytes in four adults with ITP who were treated with total doses of 1 to 1.5 g of immunoglobulin per kilogram of body weight, we found that a transient rise in platelet counts to normal levels within four to five days was accompanied by a marked temporary prolongation of the immune-particle clearance time. These data suggest that commercial intravenous immunoglobulin preparations may interfere with phagocyte Fc-receptor-mediated immune clearance. Since platelets in ITP treated with immunoglobulin were fully hemostatic, this type of therapy may allow surgical procedures to be performed safely in patients with this disease. (N Engl J Med. 1982; 306:1254–8.) DURING the past few years, increased interest has been shown in immune clearance mediated by receptors for Fc and complement, and the clinical importance of this phenomenon has also increased substantially. Early studies with nonimmune particulate materials did not reveal impaired clearance of particles from the blood in inflammatory diseases, such as systemic lupus erythematosus. 1 Application of the knowledge gained from an animal model 2 to human immune hemolytic anemia elegantly defined the role of C3b receptor and Fc receptors in mediating immune clearance. 3 On the basis of this knowledge, IgG-coated autologous erythrocytes were employed as well-defined and clinically applicable immune . . .