Refractory Immune Thrombocytopenic Purpura Accompanied with Avascular Necrosis of Femoral Head Receiving the Combination of High Dose Immunoglobulin Therapy Followed by Platelet Transfusion Could Successfully Be Managed to Undergo Surgery

Abstract

A 31 year-old male with refractory immune thrombocytopenic purpura (ITP) was accompanied with avascular necrosis of the femoral head on both sides, refractory to the following conventional therapies: high dose immunoglobulin (IgG) therapy, splenectomy, vinblastin slow infusion; maintaining a platelet count less than 20×10³/μl. He subsequently tried the combination of high dose IgG therapy with platelet transfusion from two single donors, which successfully increased the platelet count to more than 50×10³/μl for as long as 9 days. Compared to this method, platelet transfusion alone without IgG infusion failed to maintain an increase in the platelet count. These results suggest that high dose IgG may affect transfused-platelet removal in ITP. Management by the combination method enabled him to undergo surgery twice and he was able to walk with a stick six months later.