Efficacy and Safety of Immunoglobulin in the Treatment of Childhood Immune Thrombocytopenia: A Meta-Analysis

Jingxin Gong^*Linlin WangZhaoyang LiuChen Li

• Cangzhou Central Hospital, Cangzhou, China

Background: Childhood immune thrombocytopenia (ITP) is an autoimmune disorder characterized by low platelet counts, leading to increased bleeding risk. The evolution of IVIG therapy in ITP management began with groundbreaking observations in the early 1980s, when researchers unexpectedly discovered its capacity to rapidly elevate platelet counts in affected children. Immunoglobulin, commonly administered as intravenous immunoglobulin (IVIG), is used to raise platelet counts. However, the efficacy and safety of Immunoglobulin in pediatric ITP remain controversial due to inconsistent findings across studies. In this meta-analysis, we also aim to evaluate subgroup outcomes such as complete response (CR), partial response (PR), and adverse effects by dosing scheme.We conducted a systematic search of PubMed, Cochrane Library, and EMBASE for studies reporting on Immunoglobulin treatment in childhood ITP up to October 2024. The detailed search strategy is provided in Supplementary Appendix 1.Data on platelet response, adverse events, and study quality were extracted.Random-effects models were used to pool effect sizes. Heterogeneity was assessed using the I² statistic, and publication bias was evaluated via funnel plots , Egger's test, and Begg's rank correlation test.Results: Out of 432 screened studies, 18 met the inclusion criteria, comprising 1,286 children with ITP. The pooled platelet response rate was 72.4% (95% CI: 70.50-75.43%). Subgroup analysis by dose showed no significant difference between 1 g/kg and 2 g/kg regimens (x2=0.03, P=0.87). Additional subgroup analyses by age groups and ITP type (acute vs. chronic) revealed no significant differences in response rates. No severe adverse reactions were reported. Heterogeneity across studies was moderate (I² = 45%). No significant publication bias was detected (Egger's test p = 0.21; Begg's test p = 0.34).Immunoglobulin is an effective and safe treatment for childhood ITP, with a high platelet response rate and manageable side effects. Our findings provide evidence-based support for current clinical guidelines while highlighting the need for further studies to optimize dosing strategies, evaluate long-term outcomes, and identify predictors of treatment response.