Immune thrombocytopenia (ITP) leads to excessive bruising and bleeding as a result of low levels of platelets, the cells that help blood clot. Pediatric patients with ITP are typically treated with high levels of intravenous immunoglobulin G (IVIG), which contains plasma extracted from thousands of blood donations.

However, a study published in Transfusion suggests that mini-pools of immunoglobulin created with as few as 20 donations are just as sufficient in treating pediatric ITP as standard high IVIG doses. The study included 72 patients, ranging in age from 1 year to 18 years, with newly diagnosed ITP and who had low platelet counts, but no serious bleeding. They were randomly placed in 3 possible treatment groups, each containing 24 patients. Group A received 1 g/kg of mini-pool IVIG. Group B received standard IVIG treatment also at 1 g/kg. Group C received no platelet enhancing treatment.

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Approximately 16.6% of patients in group A had a response, and 58.8% had a complete response. Comparably, in group B, 16.6% of patients had a response, and 66.6% showed complete response. Only 33.3% of patients in group C had a complete response. Group A patients had a response within 8 days, group B within 9 days, and group c within 21 days.

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“Mini-pool intravenous immunoglobulin G was well tolerated, presented no safety issues, and was effective in the treatment of immune thrombocytopenia, with efficacy comparable to that of the standard intravenous immunoglobulin G group, and it was significantly more effective than no treatment,” reported the authors. Despite the positive results, they do not have any immediate plans to perform a larger scale study.


Elalfy M, Reda M, Elghamry I, et al. A randomized multicenter study: safety and efficacy of mini-pool intravenous immunoglobulin versus standard immunoglobulin in children aged 1-18 years with immune thrombocytopenia. Transfusion. 2017;57(12):3019-3025.