Use of anti-D in immune thrombocytopenic purpura as a means to prevent splenectomy: case reports from two University Hospital Medical Centers.

Presented here are 16 case studies of adults with immune (idiopathic) thrombocytopenic purpura (ITP); 5 were treated at Hackensack University Medical Center (HUMC), Hackensack, NJ, and 11 were treated at the Allegheny University Hospital (AUH), Medical College of Pennsylvania. Four of the 5 patients at HUMC had initial transient responses to intravenous immunoglobulin G (IVIg) therapy and required large doses of corticosteroids to maintain platelet counts over 50,000 microL. One elderly patient with systemic lupus erythematosus (SLE) had been treated unsuccessfully with corticosteroids and immunosuppressants to maintain her platelet count over 50,000 microL. All 5 patients were given 1 or 2 doses of anti-D at 50 microg/kg, leading to complete resolution of ITP. Following anti-D therapy, patients were tapered off corticosteroids and currently remain in complete remission with platelet counts over 100,000/ microL. The mechanism of action of anti-D in ITP remains unclear and requires further study. Treatment of the 11 patients at AUH began with corticosteroids, which resulted in no durable therapeutic response. Anti-D was then given at 50 microg/kg, and this provoked an excellent response with a prompt recovery of platelet levels to 100,000/ microL, after which active treatment was halted. Patients were monitored by direct office visit every 3 months unless a clinical indication required an earlier return. If the patient's platelets dropped below 100,000/ microL, they were first given prednisone. As of the last follow-up, all 11 patients remain stable and no patients have required splenectomy.