IMMUNE THROMBOCYTOPENIC PURPURA AND INTRAVENOUS IMMUNOGLOBULIN

The observation, in 1980, of a rapid increase in platelet counts as a result of administration of intravenous immunoglobulin (IVIG) in a patient with immune thrombocytopenic purpura (ITP) was followed by clinical studies confirming the efficacy of this new treatment alternative in ITP. Simultaneously, new sensitive assays using monoclonal antibodies against platelet glycoproteins showed that chronic ITP in adults and children is often an autoimmune disorder. There seem to be both immediate and long-term effects of IVIG in ITP which may be explained by mechanisms of action other than immunoglobulin G substitution. The mode of action of IVIG could correspond to interference with Fc receptors on phagocytes or be a result of antiidiotypic antibodies in IVIG that may induce secondary changes in the complex immunologic network. These immunomodulatory effects were the basis for the use of IVIG in the treatment of patients with other immune-related disorders. New aspects regarding definition and treatment of ITP, the possible mechanisms of action of IVIG, and the implications thereof are discussed and updated.