Comparison of the efficacy of a two-day and a five-day schedule for infusing intravenous gamma globulin in the treatment of immune thrombocytopenic purpura in adults.

The standard schedule for treating immune thrombocytopenia purpura in adults with intravenous immunoglobulin G infusion (IVIG), 400 mg/kg per day for five days, was compared with a shorter schedule using 1,000 mg/kg per day for two days. Both schedules were found to be effective in correcting thrombocytopenia. Eleven of the 17 patients treated with the five-day regimen and nine of 10 patients treated with the two-day regimen had significant responses. Patients with an initial platelet count of less than 20,000 platelets/mm3 or with an estimated in vivo platelet survival in excess of 90 hours were less likely to have a response than were other patients. There were no serious side effects in either group, but thrombophlebitis was observed in some patients receiving the five-day regimen when a single intravenous catheter was used for more than three days. Headaches and, less commonly, low-grade fever were noted in some patients receiving the two-day regimen when infusions were given at flow rates in excess of 0.04 ml/kg/minute. Since the two-day regimen requires shorter hospitalization and corrects thrombocytopenia slightly faster than the five-day course, it may be particularly useful in correcting thrombocytopenia in hospitalized patients requiring splenectomy or other surgery.