if the ANC becomes low again, there will not be

Immune Thrombocytopenia 287

up the specific infection so that even if the ANC becomes low again, there will not be a clear indication for repeated treatment. Furthermore, we have seen a high incidence of IgG2 deficiency in these patients, and infusion of MG may therefore help with more than one immunodeficiency. The ANC typically will not remain increased for long following treatment: usually it is again <500-1000/J.L} by 7-14 days. If repeated treatment is required, however, tachyphylaxis seems common in our limited experience. In the two situations in which repeated infusions were administered, we gave 1.5 g/kg infusion of IVIG combined with IV solumedrol 30 mg/kg as a single, same-day infusion to ensure continued effect.