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The sudden onset of spontaneous bleeding and profound thrombocytopenia in a previously well child is a cause for considerable concern. Treatment with intravenous immunoglobulin (IVIg) is often prescribed, which initially increases the platelet count, but whether it reduces recurrences of thrombocytopenia is uncertain.
To address this issue, Dutch investigators conducted a multicenter, phase III study, in which 200 children aged 3 months to 16 years with platelet counts ≤20,000/µL and mild-to-moderate bleeding were randomized to receive a single dose of IVIg (0.8 g/k) or careful observation.
Results were as follows:
The response rate at 1 week was higher with IVIg than with observation (68.7% vs. 23.0%; P<0.001), but this difference disappeared…