Intravenous Immune Globulin Therapy Research Articles

Ralstoniapickettii bloodstream infection in the patient with Guillain-Barre syndrome under plasmapheresis

Ralstonia pickettii is a rare Gram-negative opportunistic bacterium that causes rare infections such as bacteremia, neonatal sepsis, endocarditis, and meningitis in hospitalized or immunocompromised patients. In this study, we identified and reported bloodstream infection caused by R. pickettii in a 15 -year-old boy patient with an autoimmune disease, Guillain-Barré syndrome, under plasmapheresis and intravenous immune globulin (IVIG) therapy. He was referred for admission to the neurology center of the teaching hospital of Shiraz, Iran for inability to walk, and lower extremity muscle weakness. After he was treated with plasmapheresis once during hospitalization, and after severe fever besides shivering blood cultures using BACT/ALERT®3D instrument were positive for R. pickettii.According to antibiotic susceptibility test reports, Ciprofloxacin (5 μg) was prescribed. Fortunately, after starting antibiotic treatment, blood culture results reported no growth after 5 days. Indeed, the patient was infected with nosocomial hepatitis A and URSOBIL (300 mg/BID/Po) was administered. Hence, after reporting the infection occurrence to the hospital infection control unit, initial and possible measures such as device infection control, replacement of potentially polluted plasmapheresis fluids, disinfecting the environment and replacing old sterile washing water with new sources were carried out in plasmapheresis unit. In conclusion, R. pickettii is a rare nosocomial infection that is responsible for the contamination of medical equipment, especially in hemodialysis, plasmapheresis devices and sterile solutions. Also, it is suggested that the role and importance of rare environmental bacteria as the causative agents of human infections should not be ignored in medical centers.

MSR63 Analysis of Rare Events in Outcomes Research Using Department of Defense Data: Intravenous Immune Globulin Therapy for Bulluous Pemphiogoid

In outcomes research, we deal with rare cases frequently. If medications is just approved building a sample size on the claims datasets, which has 4-6 months lag may take some time and you had to work with small numbers for the initial studies. For certain cases, the diagnosis is real so even have a researcher have enough coverage, can not get enough sample size due to characteristics of the disease. Using a Department of Defense dataset, we analyzed a rare events and proposed a model that mitigates the bias. In particular, we analyzed the probability of using IVIg Therapy for a rare skin condition called Bullous pemphigoid.

Iatrogenic ANA: An emerging source of expensive diagnostic confusion.

Intravenous immune globulin (IVIg) therapy has been shown to be useful in a multitude of disorders. IVIg is produced from pooled human plasma; therefore, autoantibodies found in the general population are also present in IVIg and transferred to those being transfused. This can prove a particular hazard for screening and diagnostic tests based on autoantibodies. We present a patient who was found to have a positive antinuclear antibody (ANA) titer after multiple IVIg transfusions, resulting in diagnostic confusion and unnecessary workup. A 45-year-old gentleman was diagnosed with atypical CIDP, initiated on a course of IVIg, and sent for inpatient rehabilitation. However, recovery was complicated by multiple readmissions for recurrent weakness, and as part of the workup for other etiologies, an ANA was found to be positive. Sub-serologies and paraneoplastic autoantibody panel were negative. In the absence of clinical symptoms, we recommended continued monitoring and repeat ANA testing 6months after the last dose of IVIg; as any drug needs 5 half-lives to be eliminated from the body. Clinicians should consider any recent IVIg treatments when evaluating the pre-test probability of detecting an underlying connective tissue disease with ANA screening. Indiscriminate ANA levels in patients recently given IVIg lead to unnecessary and expensive further testing and consultation.

A prospective cohort study of sensorineural hearing loss associated with Kawasaki disease.

About 60 cases of sensorineural hearing loss (HL) have been reported in patients with Kawasaki disease (KD), but the current estimate of its prevalence is uncertain. The present study aimed to determine the prevalence and risk factors of sensorineural HL associated with KD. The present, prospective cohort study, conducted from May 2019 to May 2020, evaluated patients with a diagnosis of KD who received the initial therapy and underwent two auditory brainstem response (ABR) tests. HL was defined as a threshold of 40dB or more, and borderline hearing was defined as a threshold of 30dB. In total, 107 patients were enrolled, and 75 underwent two ABR tests. Thirty-one patients (30.0%) received prednisolone with their initial intravenous immune globulin and acetylsalicylic acid therapy. HL was present in only one patient who had congenital conductive HL. Five patients had borderline hearing but had normal hearing behavior. There was no significant difference between the patients with normal hearing and those with borderline hearing in terms of the clinical variables. In Japan, the prevalence of sensorineural HL after KD is not high. It may therefore be unnecessary to perform routine hearing tests for all patients with KD. Association between Kawasaki Disease and Sensorineural Hearing Loss. UMIN000037019 (the date of registration: June 11, 2019).

A Case of Rectal Malakoplakia in an Immunocompromised Woman With Chronic Colonic Bacterial Infections

A 45-year-old woman with common variable immunodeficiency and interstitial lung disease on weekly intravenous immune globulin therapy and mycophenolate mofetil presents to the gastroenterology clinic following a year of worsening diarrhea. She reports 5 to 6 nonbloody bowel movements a day with 10-lb weight loss. On colonoscopy multiple 8- to 10-mm mucosal nodules were noted in the rectum (Figure A) surrounded by patchy areas of flattened carpet-like erythematous mucosal lesions (Figure B). Biopsies of the rectal nodules and mucosa are detailed at ×200 magnification pathology slides in Figures C and D through a hematoxylin-eosin and von Kossa stain, respectively.

Adjunct Immune Globulin for Vaccine-Induced Immune Thrombotic Thrombocytopenia

SummaryThe use of high-dose intravenous immune globulin (IVIG) plus anticoagulation is recommended for the treatment of vaccine-induced immune thrombotic thrombocytopenia (VITT), a rare side effect of adenoviral vector vaccines against coronavirus disease 2019 (Covid-19). We describe the response to IVIG therapy in three of the first patients in whom VITT was identified in Canada after the receipt of the ChAdOx1 nCoV-19 vaccine. The patients were between the ages of 63 and 72 years; one was female. At the time of this report, Canada had restricted the use of the ChAdOx1 nCoV-19 vaccine to persons who were 55 years of age or older on the basis of reports that VITT had occurred primarily in younger persons. Two of the patients in our study presented with limb-artery thrombosis; the third had cerebral venous and arterial thrombosis. Variable patterns of serum-induced platelet activation were observed in response to heparin and platelet factor 4 (PF4), indicating the heterogeneity of the manifestations of VITT in serum. After the initiation of IVIG, reduced antibody-induced platelet activation in serum was seen in all three patients. (Funded by the Canadian Institutes of Health Research.)

P0731 / #2140: SARS-COV-2-RELATED MULTISYSTEM INFLAMMATORY SYNDROME IN FAMILIAL REFRACTORY HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS: A CASE REPORT

AIMS & OBJECTIVES: To describe how the clinical course of children positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tested with reversetranscriptase polymerase chain reaction (RT-PCR) has changed lately from non-severe to life threatening cases. METHODS: Case report. A 2-month-old baby arrived at the emergency department for fever, anemia, leukopenia and thrombocytopenia, he was hospitalized and diagnosed with severe dengue. A week later, he started with respiratory symptoms and fever, he was positive for SARS-CoV-2 based on RT-PCR. Two weeks later, persistent fever, C-Reactive protein and D-dimer elevation, lymphocytopenia, anemia and thrombocytopenia integrated diagnosis of multisystem inflammatory syndrome (MIS-C) treated with intravenous immune globulin, systemic glucocorticoid and anticoagulation therapy in the intensive care unit. Nevertheless, he had persistent fever, hepatosplenomegaly, pancytopenia, hypertriglyceridemia and high serum IL-6 levels;bone marrow aspiration revealed an hemophagocytic lymphohistiocytosis (HLH), so treatment with steroid, cyclosporine and cytarabine was administrated. Antibiotic therapy was added because of clinical symptoms for septic shock. Multiple transfusions because of refractory anemia and thrombocytopenia, vasopressor management and mechanical ventilation were needed. However, because of his insidious clinical course and history of infection with SARS-CoV-2, management with inhibitor of JAK signalling was added. Physical examination revealed silver hair, suggestive for a familial HLH secondary to Griscelli syndrome type 2. RESULTS: In the end, multiple organ dysfunction (cardiovascular, hematologic, respiratory, renal, neurologic). CONCLUSIONS: MIS-C was secondary to an immunemediated injury triggered by viral infections with an overall mortality greater than 50% in previously healthy children, however additional HLH resulted in fatal outcome.

Administration of intravenous immunoglobulin in the treatment of COVID-19: A review of available evidence.

Since December 31, 2019, unknown causes of pneumonia have been reported in Wuhan, China. This special pneumonia associated with a novel coronavirus was named 2019-nCoV by the World Health Organization (WHO) in January 2020. From the beginning of this infectious disease, clinicians and researchers have been endeavoring to discover an effective and suitable treatment for affected patients. To date, there is no definitive and specific treatments for coronavirus disease-19 (COVID-19) infection while drugs introduced are still in the clinical trial phase. Intravenous immune globulin (IVIG) is a biological product prepared from the serum and an optional treatment for patients with antibody deficiencies. In many countries, much attention has been paid to the use of IVIG in the treatment of patients with COVID-19. Due to the therapeutic importance of IVIG in virus infections, in the current study, we reviewed the possible effect of IVIG in viral infections and potential evidence of IVIG therapy in patients with COVID-19 virus.

Guillain-Barré syndrome following COVID-19 infection in an elderly patient: a case report

Background: Coronaviruses can affect multiple body systems and respiratory failure is the most common complication. Since the outbreak of coronavirus disease-2019 (COVID-19) in January 2020, the association between COVID-19 and Guillain-Barre syndrome (GBS) has been growing. GBS is known to be triggered by an antecedent infection, mostly viruses. Case Presentation: We present a case of GBS in an 83-year-old female patient with a confirmed COVID-19 infection. The patient initially presented with fever, cough, and fatigue. She was treated with intravenous fluid and symptomatic treatment and discharged home after stabilization. Several weeks after her initial encounter, she experienced bilateral paresthesias as well as numbness and tingling in her lower extremities. The patient’s neurological symptoms were not alleviated with standard intravenous immune globulin (IVIG) therapy; however, her symptoms significantly improved with subsequent plasmapheresis therapy. Conclusion: Based on the emerging evidence of recent studies, there is a possible connection between COVID-19 and GBS. Clinicians should be aware of the neurological manifestations of COVID-19 infection. Early diagnosis and proper treatment of COVID-19 and its neurological symptoms are crucial to increase the chance of a successful recovery.

Striational Muscle Antibody Positivity Heralding a Diagnosis of Autoimmune Encephalitis associated with Epiglottic Squamous Cell Carcinoma: A Case Report

A 59 yo woman presented to our emergency room with confusion, spells of loss of awareness over four weeks with malaise, weakness, gait difficulties, and 30 lb weight loss over one year. Brain imaging was unremarkable. EEGs revealed diffuse slowing, triphasic GPDs, and left temporal epilepti form discharges. Spinal fluid showed an elevated protein count. She received a working diagnosis of autoimmune encephalitis and received steroids and antiepileptic medications. She experienced an improvement in symptoms and went home. Follow up revealed elevated striational muscle antibodies and enhancement of spinal nerve roots suggesting an autoimmune neurological syndrome. She received intravenous immune globulin (IVIg) therapy and had periods of improvement followed by worsening a few months later with each dose of IVIg. She presented to the hospital a year with worsening dysphagia and an endoscopy showing an epiglottic mass. Pathology confirmed squamous cell carcinoma, and she received chemotherapy and radiation. We wish to share this rare case of autoimmune encephalitis presenting with only striational antibodies as a heralding sign of a tumor. We postulate that, in the correct context, the presence of striational antibodies alone, despite low titers, may support a diagnosis of autoimmune encephalitis from underlying malignancy.

Single-center report of antibody deficiencies in Azerbaijan

Abstract The most common type of Primary Immune Deficiencies (PID) are Antibody Deficiencies (AD) characterized by the recurrent bacterial infections. Usually the immune disbalance is observed as a decrease in B-cell function, hypogammaglobulinemia and deficiency of IgG and IgA or all three IgG, IgA and IgM antibodies. Early onset acute or chronic infections in gastrointestinal, respiratory and urinary tract are the most common symptoms of AD. The aim of the study was to analyze the data of 126 pediatric and adult patients diagnosed as AD in our PID center between 2010–2019. Immune status of the patients was examined by phenotyping of immune cells in peripheral blood, measurement of serum IgM, IgG, IgA and IgE levels, evaluation of phagocytic activity by NBT, and detection of CIC by photometric method. Additional abdominal CT and ultrasound examinations were also performed. From 126 pediatric and adult patients registered in PID Center, Baku, Azerbaijan, 9 patients were diagnosed with sIgA deficiency, 26 were common variable immune deficiency, 9-Bruton disease and 2 patients with Hyper IgM syndrome. Patient cohort included 5 adults and 41 between 12 months to 11 years age. At the time of the study, 37 patients were receiving intravenous immune globulin (IVIG) as a replacement therapy (31 patients were on regular IVIG). IVIG therapy was associated with decreased incidence of infections and overall improvement in well-being of the patients. It is important to consider hypogammaglobulinemia in patients with a history of recurrent and severe infections. We recommend that patients’ immune status should be examined including evaluation of serum immunoglobulin levels and B and T-cell subsets.

New treatment strategies for systemic vasculitis: the role of intravenous immune globulin therapy

Intravenous immune globulin (IVIG) is now under evaluation for the treatment of patients with the forms of systemic vasculitis associated with anti-neutrophil cytoplasmic antibodies (ANCA). Although IVIG may produce effects by a variety of mechanisms, including control of T-cell function, interference with cytokine action, and Fc receptor blockade, it is the regulation of autoantibody production by B cells, through idiotypic-anti-idiotypic reactions, that makes this treatment attractive for patients with systemic vasculitis. The author and others have shown the importance of ANCA idiotypic-anti-idiotypic reactions in vitro and demonstrated that these could be influenced by anti-idiotypic determinants present in IVIG. Thus F(ab')2 fragments of IVIG could block ANCA binding to antigen, in a dose-dependent fashion. The degree of inhibition was variable, ranging up to 100% for the ANCA-containing sera of certain patients. Similar inhibitory activity could be found in the sera of patients in remission after treatment, as well as in occasional patients whose disease remitted spontaneously, without drugs being used. Thus, IVIG appears to be particularly valuable in the management of vasculitis in the elderly, the very young and for pregnant women, as well as for those at any age who are vulnerable to infection.

A Postmortem Study of a Patient with Low Titer Nicotinic Acetylcholine Receptor Ganglionic Antibody: Implications for Clinical Neurologic Disease

Small fiber polyneuropathy is a well-recognized syndrome mitigated by somatic sensory afferent and autonomic efferent nerve fibers that respectively mediate pain, heat and cold temperature afferent and autonomic efferent function in the skin. A patient with low serum titers of neuronal acetylcholine receptor ganglionic antibodies and autonomic failure had symptomatic small fiber polyneuropathy late in life in the setting of autoimmune dementia and encephalopathy and prostate cancer. Large and small fiber polyneuropathy and dysautonomia were detected in routine electrodiagnostic and autonomic laboratory studies, and epidermal nerve fiber analysis of the calf and thigh. Clinical improvement for one year concomitant with intravenous immune globulin therapy preceded a clinical decline in neurocognitive function and death. Postmortem examination showed typical features of Alzheimer disease with neuropathic neuropathological changes in the peripheral nervous system, and viable autonomic ganglia consistent with a channelopathy mechanism involving postsynaptic neuronal nAChRs.

Immune deficiency derive a favorable response to IVIg in PANDAS

For two decades, pediatric autoimmune neuropsychiatric disorder associated with group a beta hemolytic streptococcal infection (PANDAS) has been treated with high-dose intravenous immune globulin (IVIg) therapy based upon the understanding that the disorder is partly due to post-infectious dysimmunity.

Infection-induced autoimmune encephalopathy: Treatment with intravenous immune globulin therapy. A report of six patients

Infection-induced autoimmune encephalopathy: Treatment with intravenous immune globulin therapy. A report of six patients

Rituximab for Treatment of Refractory Anti-NMDA Receptor Encephalitis in a Pediatric Patient

Anti-N-methyl d-aspartate receptor (anti-NMDAR) encephalitis is a devastating disease that is increasingly being identified in both children and adults with psychosis, language disturbances, behavioral changes, and motor deficits. Currently no consensus guidelines exist for the optimal management of patients with this disease, although intravenous immune globulin (IVIG) therapy is often considered first-line pharmacotherapy. We present a case of an otherwise healthy 4 year-old-child who presented with seizures, loss of age-appropriate language skills, and behavioral changes, in whom anti-NMDAR was subsequently diagnosed. After marked intolerance to corticosteroid therapy and inadequate clinical response to IVIG, immunotherapy with rituximab was initiated. The patient had rapid return of language skills and complete resolution of dyskinesia after a single rituximab infusion, with no residual deficits at her 6-month follow-up visit. Early intervention in patients with anti-NMDAR encephalitis is of paramount importance for successful outcomes and baseline recovery. Only approximately half of patients respond to first-line immunotherapy, necessitating further evaluation of alternative therapies and the development of a treatment algorithm for practitioners. This case report builds upon previous findings illustrating rapid symptom resolution after rituximab infusion and adds to the available body of evidence for management of pediatric patients with anti-NMDAR.

Serum IgG levels and mortality in patients with severe sepsis and septic shock : The SBITS data.

The role of intravenous immune globulin (Ig) therapy in patients with severe sepsis and septic shock is discussed controversially. Low initial IgG levels could help to identify those patients who might benefit from an adjunctive Ig treatment. To investigate the effect of initial serum IgG levels on 28-day mortality in patients with severe sepsis and septic shock. In this retrospective analysis of the SBITS trial data, 543 patients were allocated to four groups (quartiles) depending on their initial serum IgG levels (1: IgG≤ 6.1g/l; 2: IgG 6.2-8.4g/l; 3: IgG 8.5-11.9g/l; 4: IgG> 11.9g/l). The third quartile was taken as the reference quartile. For the applied logistic regression model clinically relevant confounders were defined and integrated into further risk-adjusted calculations. Patients with the lowest IgG levels had amortality rate similar to those patients with initial IgG levels in the second and third quartile, representing the physiological IgG range in healthy people. Surprisingly, patients with the highest IgG levels even showed asignificantly higher mortality in arisk-adjusted calculation compared to the reference quartile (OR1.69, CI 1.01-2.81, p= 0.05). Subgroup analyses revealed that initial IgG levels were of no prognostic value in patients presenting with vasopressor-dependent septic shock on admission as well as in patients with either gram-positive or gram-negative sepsis. Initially low IgG levels do not discriminate between survival and nonsurvival in patients with severe sepsis and septic shock. Therefore, low IgG cannot help to identify those patients who might benefit from an adjunctive IgG sepsis therapy. Whether ahigh initial IgG serum level is an independent mortality risk factor needs to be investigated prospectively.

Intravenous immune globulin suppresses angiogenesis in mice and humans.

Human intravenous immune globulin (IVIg), a purified IgG fraction composed of ~60% IgG1 and obtained from the pooled plasma of thousands of donors, is clinically used for a wide range of diseases. The biological actions of IVIg are incompletely understood and have been attributed both to the polyclonal antibodies therein and also to their IgG (IgG) Fc regions. Recently, we demonstrated that multiple therapeutic human IgG1 antibodies suppress angiogenesis in a target-independent manner via FcγRI, a high-affinity receptor for IgG1. Here we show that IVIg possesses similar anti-angiogenic activity and inhibited blood vessel growth in five different mouse models of prevalent human diseases, namely, neovascular age-related macular degeneration, corneal neovascularization, colorectal cancer, fibrosarcoma and peripheral arterial ischemic disease. Angioinhibition was mediated by the Fc region of IVIg, required FcγRI and had similar potency in transgenic mice expressing human FcγRs. Finally, IVIg therapy administered to humans for the treatment of inflammatory or autoimmune diseases reduced kidney and muscle blood vessel densities. These data place IVIg, an agent approved by the US Food and Drug Administration, as a novel angioinhibitory drug in doses that are currently administered in the clinical setting. In addition, they raise the possibility of an unintended effect of IVIg on blood vessels.

Infection-Induced Autoimmune Encephalopathy: Treatment with Intravenous Immune Globulin Therapy. A Report of Six Patients

Objective: To present illustrative patients with infection-induced autoimmune encephalopathy (IIAE) who manifest symptoms and signs of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and are successfully treated with an anti-infective and immune modulatory protocol. Methods: Six children age 5 to 17 years with the diagnosis of IIAE associated with various infections and comorbid conditions including humoral immunodeficiency and Autism Spectrum Disorder (ASD) are described. Pertinent literature from 1958 to the present is reviewed. Antimicrobial and high dose (1 gram per kilogram total body weight) intravenous immune globulin (IVIg) therapy was administered every 8 weeks according to an established anti-infective and immune modulatory protocol. Informed consent by the parents and legal authorization was obtained in all cases. Neuroradiological testing was not performed in any of the cases. Results: The combination of antimicrobial medication followed by IVIg in this cohort was well-tolerated leading to improvement in symptoms and signs of IIAE allowing tapering or discontinuation of maintenance medications. Conclusion: IVIg is a safe and beneficial therapy in IIAE, PANDAS and ASD impacting favorably on underlying humoral immune deficiency and infectious-induced CNS autoimmunity in this small and highly selected cohort. The present findings are awaiting further replication by other investigators and should be further explored relative to the optimal dose and duration of therapy.

Retrospective Analysis of Clinical Response in Children with Severe Immune Thrombocytopenia Undergoing Treatment with Intravenous Immune Globulin

Background:Childhood immune thrombocytopenia (ITP) is a common bleeding disorder characterized by an isolated thrombocytopenia resulting from unknown causes, commonly presenting between 1 to 10 years of age. Nearly one child in 20,000 will experience ITP each year in the United States. The American Society of Hematology recommends that children with platelet counts of <20,000/μL and significant mucous membrane bleeding, or with platelet counts of <10,000/μL and minor purpura, should receive treatment with intravenous immune globulin (IVIg), IV RhIG, or corticosteroids.Objective:The objectives of this retrospective analysis was to determine if pediatric patients with severe ITP are responding to IVIg treatment with or without concomitant corticosteroids and if different IVIg products have any difference in response. We evaluated mean platelet counts at initial presentation and following IVIg therapy. The endpoints of this study were rate, degree, and rapidity of the platelet count response, cost of treatment, adverse effects and comparison of these with different IVIg products.Methods:This study was a single center, retrospective analysis of patients undergoing IVIg treatment for severe ITP. After institutional IRB approval, subjects were identified through Intermountain's Enterprise Data Warehouse. Subjects were pediatric patients aged ≤18 years of age with immune thrombocytopenia that received treatment with IVIg from January 2009 through April 2015. Patients were eligible for inclusion if they had an initial platelet level of <20,000/mm3 drawn within 48 hours prior to starting IVIg therapy and at least one platelet level within seven days following IVIg administration. Patients were excluded if they received a platelet transfusion prior to IVIg therapy. Platelet increase was assessed by analyzing the mean difference in platelet increase between initial values preceding IVIg administration compared to the highest drawn platelet level within a 7 day period post-IVIg therapy. Three different IVIg products were used which included Gammagard, Gammagard S/D and Gamunex. Response was defined as a platelet rise to at least 20,000/mm3. Cost-effectiveness was also evaluated.Results:At Primary Children's Hospital between January 2009 and April 2015, approximately 150 patients were diagnosed with ITP, the majority of whom were either observed without treatment or received corticosteroid therapy. Forty six patients were identified as having severe ITP requiring IVIg therapy, of which 72% were males. Median age of ITP patients receiving IVIg was 8 years. Twelve patients were excluded, as eight patients received platelet transfusions, three patients had initial platelet levels above 20,000/mm3, and one patient did not have a documented follow-up platelet level. This left 34 eligible patients for data analysis. Twelve patients (35%) received both IVIg and steroids. Twenty two patients (65%) had an appropriate platelet response within the 7 day period. The mean platelet increase was 76,000/mm3 in patients who received IVIg. Mean platelet increase of 88,000/mm3 was observed in patients receiving only IVIg therapy, compared to 53,000/mm3 in patients receiving both IVIg and corticosteroids. Seventy-six percent of patients received Gammagard with an average platelet response of 88,000/mm3, of which 69% responded by day 7. Twelve percent of patients received Gamunex with an average platelet response of 89,000/mm3, of which 75% responded by day 7. Twelve percent of patients received Gammagard S/D with an average platelet response of 10,000/mm3, of which 25% responded by day 7. Average IVIg cost per patient was $2,736 with a mean expense of $36 per 1000/mm3 increase in platelet counts.Conclusion: Similar to other published reports, patients with severe ITP responded well to IVIg therapy. Patients who failed to respond to initial steroid treatment experienced a platelet response with concomitant corticosteroid and IVIg therapy. Though the numbers are small, our study suggests for the first time that IVIg product with >98% IgG levels (i.e. Gammagard, Gamunex) have better response rates than Gammagard S/D which has 90% IgG level. Further analysis needs to be completed evaluating duration of therapeutic effect from IVIg. This information will be used to help detect a clinically meaningful response to IVIg therapy directed at increasing platelet counts and preventing ITP complications. DisclosuresNo relevant conflicts of interest to declare.