CRD Summary: The authors concluded that a single dose of 50 μg/kg IV Rh(D) immunoglobulin G (anti-D) was effective in raising the platelet count to at least 20 x109/L in approximately 70% of children within 3 days, with fewer side-effects than intravenous immunoglobulin G. Given the lack of a formal validity assessment and the potential for error and bias in the review, the conclusions should be treated with caution.

CRD Commentary: The research question was clearly defined for the population and intervention, but not for study design. The outcomes did not appear to be defined a priori and in some studies the end point was defined as 'PLT increase', which makes it difficult to evaluate the clinical impact of the intervention. Only one database was searched and it is unclear whether any attempts were made to minimise publication and language bias, therefore important data might have been missed. A formal validity assessment was not carried out and there was insufficient information on study design to determine the quality of the included studies; the reliability of the results is therefore unclear. One limitation evident from the review was the small sample size of many included studies. Given the clinical heterogeneity in the included studies, the decision to use a narrative synthesis was appropriate. However, many studies also included adults or children who did not have ITP, some of whom received other treatments. There was insufficient information about the data extraction process to determine how the data for children with ITP receiving anti-D were isolated, therefore error and bias cannot be ruled out. Furthermore, p-values were not reported where appropriate, which makes it difficult to assess the significance of the results. The authors' conclusions follow from the study results. However, inadequate reporting renders it difficult to assess the quality of the review process and, therefore, limits the reliability of the authors' conclusions.