Passive neonatal thrombocytopenia. A case study of factors predicting the response to i.v. IgG therapy.

A term male infant was noted at birth to have petechiae over the face and trunk and a platelet count of 3 x 10(9) per L. Maternal immune thrombocytopenia (ITP) was suspected from the clinical data and confirmed by the presence of antiplatelet antibody (both in the mother and infant) detected by recently described flow cytometry method. Initial treatment with exchange transfusions, platelet transfusions, steroids, failed to correct thrombocytopenia and, hence, seven doses of high-dose gamma globulin (IV-IgG) were given intravascularly. Initiation of IV-IgG was followed by stabilization of platelet counts with marked reduction in the need for platelet transfusions. In this case of passive ITP, the therapeutic efficiency of high dose IV-IgG seems to depend upon maintaining a certain critical level of serum IgG (which in turn may depend upon the serum antiplatelet antibody titers).