Treatment for ITP is recommended for a platelet count less than 30×109/L. Corticosteroids are considered first-line treatment, with the addition of IVIG reserved for severe ITP in the setting of serious bleeding, when a rapid rise in platelets is required, or when corticosteroids are contraindicated. There is no evidence of benefit of IVIG in combination with corticosteroids for first-line treatment of asymptomatic ITP. If IVIG is required, the dose should initially be 1g/kg as a single time dose. This dose may be repeated if necessary. The financial implications of IVIG use are substantial: a single infusion cost between 5,000 to 12,000 CAD, and for patients requiring monthly infusions may incur annual costs of 60,000 to 100,000 CAD placing a significant burden on our healthcare system. Unnecessary IVIG infusions can result in multiple adverse effects, including acute hemolytic or anaphylactic reactions, thromboembolic events, and aseptic meningitis.
Sources:
Health Quality Ontario. Intravenous immune globulin for primary immune thrombocytopenia: a rapid review [Internet]. 2014 [cited 2017 Jun 29].
Neunert C, et al. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. Apr 21 2011;117(16):4190-4207. PMID: 21325604.
Neunert CE. Current management of immune thrombocytopenia. Hematology Am. Soc. Hematol. Educ. Program. 2013;2013:276-282. PMID: 24319191.
Provan D, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. Jan 14 2010;115(2):168-186. PMID: 19846889.