Jiajia Liu1, Katerina Pavenski2, Michelle Sholzberg3. 1. Division of Adult and Pediatric Hematology, University of Toronto, 190 Elizabeth Street, R. Fraser Elliott Building, 3-805, Toronto, ON, M5G, Canada. Electronic address: jiajia.liu@mail.utoronto.ca. 2. Division of Adult and Pediatric Hematology, University of Toronto, 190 Elizabeth Street, R. Fraser Elliott Building, 3-805, Toronto, ON, M5G, Canada. Electronic address: PavenskiK@smh.ca. 3. Division of Adult and Pediatric Hematology, University of Toronto, 190 Elizabeth Street, R. Fraser Elliott Building, 3-805, Toronto, ON, M5G, Canada; Departments of Medicine and Laboratory Medicine, St. Michael's Hospital, 30 Bond St., Toronto, ON, M5B 1W8, Canada; Li Ka Shing Knowledge Institute, 209 Victoria St, Toronto, ON, M5B 1T8, Canada. Electronic address: sholzbergm@smh.ca.
Abstract
OBJECTIVES: Assess the appropriateness of the use of intravenous immunoglobulin (IVIG) for immune thrombocytopenia (ITP). BACKGROUND: IVIG is suggested for ITP when a rapid increase in platelet count is desired or as first line therapy if corticosteroids are contraindicated. A recent Canadian audit of IVIG requests found a lack of compliance with provincial requirements and inadequate documentation of efficacy which led the authors to conclude that the use of IVIG was broadly inappropriate for all treated diseases. METHODS: Retrospective review of patients with ITP who received IVIG at our institution over a one-year period. RESULTS: 40 patients received IVIG for ITP over the study period for a total of 76 infusions. The most common indications for IVIG within currently accepted guidelines were: active bleeding (13, 17%), pre-operative or antepartum care (22, 29%), contraindication to corticosteroids (8, 11%), and requirement for antithrombotic or myelosuppressive therapy (5, 7%). Indications that fell outside of guidelines included use of IVIG as a diagnostic challenge where the etiology of thrombocytopenia was unclear. IVIG was generally well tolerated. CONCLUSION: At our institution, use of IVIG for ITP was generally appropriate and carefully considered. Detailed utilization/knowledge data inquiries are required to develop tools and policies to enhance appropriate IVIG use in multiple settings.
OBJECTIVES: Assess the appropriateness of the use of intravenous immunoglobulin (IVIG) for immune thrombocytopenia (ITP). BACKGROUND: IVIG is suggested for ITP when a rapid increase in platelet count is desired or as first line therapy if corticosteroids are contraindicated. A recent Canadian audit of IVIG requests found a lack of compliance with provincial requirements and inadequate documentation of efficacy which led the authors to conclude that the use of IVIG was broadly inappropriate for all treated diseases. METHODS: Retrospective review of patients with ITP who received IVIG at our institution over a one-year period. RESULTS: 40 patients received IVIG for ITP over the study period for a total of 76 infusions. The most common indications for IVIG within currently accepted guidelines were: active bleeding (13, 17%), pre-operative or antepartum care (22, 29%), contraindication to corticosteroids (8, 11%), and requirement for antithrombotic or myelosuppressive therapy (5, 7%). Indications that fell outside of guidelines included use of IVIG as a diagnostic challenge where the etiology of thrombocytopenia was unclear. IVIG was generally well tolerated. CONCLUSION: At our institution, use of IVIG for ITP was generally appropriate and carefully considered. Detailed utilization/knowledge data inquiries are required to develop tools and policies to enhance appropriate IVIG use in multiple settings.