Very low-dose intravenous immunoglobulin for treatment of immune thrombocytopenic purpura.

A nine-year-old boy presented to us with complaints of fever, cough and pin point red spots over the body for 2 days. He also had one episode of bleeding from nose. On examination he had petechial spots scattered all over the body. There was no hepato-splenomegaly. Complete blood count showed haemoglobin of 11.4 g/dL, white blood cell 8000/mm3 and platelet 8,000/mm3. Peripheral blood smear was normal other than severe thrombocytopenia and large platelets. The bone marrow examination showed megakaryocytes, which were present in increased numbers. Patient was started on IV methylprednisolone (20 mg/kg/day) for 3 day then switched to oral prednisolone. With this treatment, platelet count increased to 45000/mm3. Patient again presented after 10 days with platelet counts of 10,000, multiple petechial spots and gum bleeding. Patient was started on intravenous anti-D rhesus (75 μg/kg) but no response was noted. At this stage it was planned to give IVIG but due to cost constraints, patient was given single very low dose of IVIG (100 mg/kg). Bleeding stopped and platelet count increased to 26,000/mm3 after 1 day, 68,000/mm3 after 2 days, 140,000/mm3 after 3 days of IVIG therapy. Four weeks after therapy platelet count was 72,000/mm3.