Intravenous Gamma-Globulin (Sandoglobulin®) Therapy in the Management of Four Patients with Immune Thrombocytopenic Purpura

Abstract

We have used intravenous polyvalent intact gamma-globulin concentrate (Sandoglobulin ®-immune globulin IV) in the management of 2 adults and 2 children with refractory immune thrombocytopenic purpura (ITP). Excellent responses were obtained in 2 children with chronic ITP as compared to no response in 2 adults with long-standing, severe ITP. The 2 adults who failed intravenous Sandoglobulin therapy had prolonged reticuloendothelial system (RES) clearance of autologous antibody-coated red blood cells before initiation of therapy as compared to normal RES clearance rates in the 2 children who responded to therapy. Blockade of the RES is one mechanism by which intravenous Sandoglobulin therapy may reverse thrombocytopenia in ITP - our observations suggest that patients who have impaired RES function before starting intravenous Sandoglobulin therapy may fail to respond to treatment. Continued studies are required to confirm these observations.