BACKGROUND. ITP is an acute disease in children characterized by bleeding manifestation with spontaneous remission. However, some develop severe bleeding which maybe life threatening.

OBJECTIVE. To determine the difference in proportion of patients who achieved a rise in platelet count in patients with acute immune thrombocytopenic purpura treated with corticosteroids or IVIG.

METHODS. A systematic search of articles utilizing a search strategy was performed to identify relevant articles according to prior inclusion and exclusion criteria. Data sources included Medline, EMBASE, Cochrane, Pediatric Hematology and Oncology, Pediatrics and Journal of Pediatrics (all up to 2005). Fixed effects and random effects models were used to determine summary effects estimates.

OUTCOME MEASURE. Difference in proportion of patients who achieved the desired platelet count between treatment groups.

RESULTS. Analysis of 9 randomized controlled trials showed that IVIG produced an additional 12-14% increase in proportion of patients with platelet count >20 x 10 9/ L and 18% increase in proportion of patients with platelet count >50 x 10 9 / L on days 2 to 4. No significant differences were seen between the treatment groups on days 14 and 28 except for platelet count >50 x 10 9 /L.

CONCLUSION. IVIG is more effective than corticosteroids in raising the platelet count during the early part of treatment.