Tahira Zafar, Muhammad Yousaf, Muhammad Saleem, Zaheer Ud Din.
High dose intravenous immunoglobulins as a life saving measure in chronic autoimmune thrombocytopenia.
Pak J Pathol Jan ;7(2):45-6.

A 32 years old female presented at combined military hospital (CMH) Rawalpindi with generalized purpura, gum bleeding and severe menorrhagia of seven days duration. Her platelet count on admission was 3x109/l. She had a past history of development of similar complaints two years ago. She was fully investigated and after a bone marrow aspirate, was diagnosed as having autoimmune thrombocytopenic purpura. She was given prednisone at a dose of 1 mg/kg body weight to which she partially responded with platelets ranging .between 50-60 x109/l. She remained clinically stable till she presented with bleeding and severe thrombocytopenia. In view of her previous response to steroids she was again given prednisone (1 mg/kg body weight). Her platelet count improved slightly from 3x109/I to 16x10911 with some reduction of bleeding. This was followed a week later by a drop in her platelet count to 8x109/l. She became clinically unstable with severe headache, abdominal pains, haematemesis and malena. As she did not respond to steroids, splenectomy was chosen as the next option. This was not possible with her low platelet count. It was decided at this critical stage to give her high dose intravenous immunoglobulins in order to raise her platelet count prior to splenectomy. She was given 0.4 g/kg body weight of Gamimune (Cutter) daily for five days. Her platelet count showed a rise after six days of starting the intravenous immunoglobulin infusion and reached a level of 157x10 /I on the tenth day. Splenectomy was done at this stage without any problems and she made an uneventful recovery.

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