Twenty studies (n=719) were included in the review; 422 children were treated with anti-D. Two studies were RCTs (56 children treated with anti-D). There was insufficient information to ascertain the designs of the other trials.
There were 14 studies of IV anti-D (367 children treated with anti-D). In general, 70% of Rhesus-positive non-splenectomised children with acute or chronic ITP showed a PLT count increase to ≥20 x109/L within 3 days after IV anti-D treatment. In at least 60% of children the PLT count increased to ≥50 x109/L within 3 to 10 days. One RCT found that IV anti-D at a dosage of 25 μg/kg on 2 consecutive days resulted in a slower increase in PLT count compared with IV IgG and prednisolone (no p-values reported). Another RCT found that treatment with IV IgG resulted in a significantly higher PLT count than anti-D at 3 and 7 days post-treatment in children with chronic ITP (no p-values reported).
Adverse effects of nausea, headache, fever, chills and vomiting were reported in 3 to 15% of patients in 5 studies. One RCT found a higher incidence of side-effects in children treated with IV IgG (no p-values). Anti-D mediated haemolysis with haemoglobin decrease from 0.5 g/dL was observed in most patients in 7 studies (no statistical values provided). In one trial where anti-D was compared with IV IgG, similar levels of haemoglobin decrease were observed with IV IgG and anti-D treatments. A small number of children experienced renal failure and haemolysis. No HIV-positive thrombocytopenic children experienced excess toxicity (2 studies).
In terms of other routes of administration of anti-D, in the 2 studies that looked at in vitro opsonised erythrocytes (19 children treated with anti-D), the researchers found a similar level of efficacy in raising PLT count to that found in IV studies. Intramuscular anti-D was also found to be effective (3 studies, 34 children treated with anti-D). One study used subcutaneous administration of anti-D in 2 children and found it to be effective in raising the PLT count. No statistical information or p-values were reported for these interventions.