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:
Neunert C, et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 2019 Dec 10;3(23):3829-3866. Erratum in: Blood Adv. 2020 Jan 28;4(2):252. PMID: 31794604.