| Objectives:To compare the effectiveness and safety of intravenous anti-D immunoglobulin (IV anti-D) with high dose intravenous immunoglobulin (IVIG) as initial treatment of children with acute idiopathic thrombocytopenic purpura (ITP).Study design:A systematic review and meta-analysis of randomized controlled trials comparing anti-D with high dose IVIG for childhood acute ITP. Studies were identified from three electronic databases and hand-searched reference lists. Two authors independently reviewed potentially eligible studies and extracted data. The number of patients with a platelet count>20×109/L,72hours after treatment initiation, and the decrease in hemoglobin were the primary outcomes. The statistic analyses were performed by RevMan5.1. If there was no significant statistical heterogeneity identified from included studies, relative risks (RR) were pooled using a fixed effects model. Otherwise, a random effects model was used.Results:A total of771articles were retrieved, and five studies were included. The RR (anti-D versus high dose IVIG) of achieving a platelet count>20×109/L at72hours was0.90(95%CI:0.82～0.98). However, subgroup analyses suggested no significant difference between anti-D50μg/kg and high dose IVIG (RR0.98,95%CI:0.84～1.13), as well as between anti-D75μg/kg and high dose IVIG (RR0.88,95%CI:0.75～1.03). Hemoglobin drop was greater in the anti-D group. No patients, however, required transfusions of erythrocyte suspensions.Conclusions:Ⅳ anti-D may be as effective as high dose IVIG for childhood acute ITP after72hours post-therapy. The side effects of anti-D were tolerated and acceptable. |
