Why should intramuscular anti-D be different from intravenous anti-D? COMMENT

For reasons of safety the use of intravenous anti D to treat ITP has largely been abandoned because of the risk it incurs of intravascular haemolysis. Intramuscular delivery of anti-D could be a safer approach and deserves to be further evaluated. IV anti-D was a mainstay of ITP treatment in the United States in the 1990's until the development of intravascular hemolysis (IVH) and its serious even fatal consequences was appreciated. Subsequently, treatment of patients with ITP with IV anti-D has become very rare given other alternatives and the IVH risk. IM anti-D does not carry a risk for IVH and it should be re-evaluated and reconsidered as an option for D+ DAT-negative not splenectomized adults who do not have a long duration of ITP and require maintenance treatment.

Automated summary

The use of intravenous anti-D for treating ITP has been largely abandoned due to the risk of intravascular hemolysis. Intramuscular delivery of anti-D could be a safer approach and needs further evaluation. IV anti-D was widely used for ITP treatment in the United States in the 1990s until the discovery of its risk for intravascular hemolysis. As a result, it is now rarely used due to the availability of alternative treatments. IM anti-D, on the other hand, does not carry the risk of intravascular hemolysis and should be reconsidered as an option for certain adult patients with ITP.