[Refractory immune thrombocytopenic purpura accompanied with avascular necrosis of femoral head receiving the combination of high dose immunoglobulin therapy followed by platelet transfusion could successfully be managed to undergo surgery].

A 31 year-old male with refractory immune thrombocytopenic purpura (ITP) was accompanied with avascular necrosis of the femoral head on both sides, refractory to the following conventional therapies: high dose immunoglobulin (IgG) therapy, splenectomy, vinblastin slow infusion; maintaining a platelet count less than 20 x 10(3)/microliters. He subsequently tried the combination of high dose IgG therapy with platelet transfusion from two single donors, which successfully increased the platelet count to more than 50 x 10(3)/microliters for as long as 9 days. Compared to this method, platelet transfusion alone without IgG infusion failed to maintain an increase in the platelet count. These results suggest that high dose IgG may affect transfused-platelet removal in ITP. Management by the combination method enabled him to undergo surgery twice and he was able to walk with a stick six months later.