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Correspondence
Outcome of national oversight of intravenous immunoglobulin prescribing in immune thrombocytopenia
  1. Siraj A Misbah1,
  2. Mike F Murphy2,
  3. Sue Pavord2,
  4. Quentin Hill3,
  5. Rob Coster4,
  6. Miranda Matthews5,
  7. Mark Foster6
  1. 1 Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
  2. 2 Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
  3. 3 Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  4. 4 NHS England and NHS Improvement South East, Reading, UK
  5. 5 NHS England and NHS Improvement Midlands, Birmingham, UK
  6. 6 Medical Data Solutions and Services, Manchester, UK
  1. Correspondence to Dr Siraj A Misbah, Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK; siraj.misbah{at}ouh.nhs.uk

https://doi.org/10.1136/jclinpath-2020-207037

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    Intravenous immunoglobulin (IVIg) is a plasma-derived product, whose use is well established as an effective short-term treatment for patients with immune thrombocytopenia (ITP) who either fail to respond to steroids or require a rapid increase in platelet count following acute haemorrhage or prior to surgical intervention. Its use is underpinned by national and international guidelines.1 2

    Concerns about the supply of IVIg in the face of increasing use and plasma shortages led the United Kingdom’s Department of Health (UKDH) to institute a demand management programme in 2008.3 Data on IVIg use since 2012 have been centrally recorded for various indications spanning antibody replacement to immunomodulation, including in ITP. Despite recommendations from the UKDH and the American Society for Hematology that IVIg should be dosed at 1 g/kg for ITP,2 3 analysis of data recorded on the National Immunoglobulin Database on usage for ITP between 2012 and 2015 revealed that these recommendations …

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    Footnotes

    • Handling editor Mary Frances McMullin.

    • Contributors SAM conceived and wrote the manuscript. MFM, SP and QH critically reviewed and edited content. RC and MM critically reviewed content and were involved in national implementation of the Ig policy. MF provided and validated data on Ig use in ITP.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests SAM chairs the Immunoglobulin Policy Working Group at NHS England.

    • Provenance and peer review Not commissioned; externally peer reviewed.