A HaemSTAR-led, UK-wide ‘flash-mob’ audit of ­intravenous immunoglobulin use in immune ­thrombocytopenia

Intravenous immunoglobulin (IVIg) is a common therapy for patients with immune thrombocytopenia (ITP). The initial response rate for IVIg is 80%1 and is typically rapid, with some patients responding in 24 hours, although usually in 2–4 days.2 When IVIg is used alone, the response is relatively short, averaging around 2–4 weeks. Potential side effects include headache, renal failure, thrombosis and transfusion-transmitted infection. The cost of IVIg is significant, averaging £400 for 10 g.3 Historic dosing regimens for IVIg are either 1 g/kg/day for 1–2 days or 0.4 g/kg/day for 5 days.4 There are data to suggest an increased likelihood of response with 1 g/kg/day for 1–2 days than with 0.4 g/kg/day for 5 days.5 Recent guidance from NHS England recommends 1 g/kg for 1 day, with a second dose of 1 g/kg at 7 days only if there is failure to achieve a haemostatically adequate platelet count.6 Using the optimal dosing regimen is important for maximum efficacy, the avoidance of side effects and prudent healthcare. HaemSTAR (Haematology Specialty Trainee Audit and Research) is a UK-wide network of clinical haematology registrars that is supported by the National Institute of Health Research (NIHR) Haematology Clinical Research Network (CRN). We have members in each NIHR local CRN who coordinate local research activity and involvement of other participants as is needed. Our overarching aim is to promote clinical research in non-malignant haematology. One way that we intend to do this is by enabling effective transition of worthy local audits to a national scale.