Acute ITP is a common cause of thrombocytopenia in children. Despite many clinical trials the management of acute ITP in children remains controversial. Oral corticosteroids are inexpensive, but the platelet response is often slow. Anti-D therapy is less expensive and labor intensive than IVIg, however, its comparative efficacy in acute ITP has not been studied thoroughly. In this retrospective study, the efficacy of IVIg and Anti-D treatment for acute ITP was compared. Nineteen children diagnosed with acute ITP from Dec. 1995 to Dec. 1996 were given either IVIg or Anti-D (Rh+ patients only) as initial therapy. The IVIg group (n=9) had a mean age of 11.5 years (1.7≈18 years) and a pretherapy platelet count of 6.0 ± 7.2 × 103/μL. The Anti-D group (n=10) had a mean age of 5.8 years(1.1≈13.4 years) and a pretherapy platelet count of 12.4 ± 7.7× 103/μL. The time to achieve a platelet count ≥ 20,000/μL was 1.42 ± 0.43 days (range 1 to 2.5 days) in the IVIg group, and 1.41 ± 0.84 days in the Anti-D group (range 0.47 to 2.7 days). The time to achieve a platelet count ≥ 40,000/μL was 1.38± 0.40 days in the IVIg group (range 1 to 2.25 days) and 1.69 ± 1.16 days in the Anti-D group (range 0.56 to 4 days). Hospital treatment time was similar in both groups. Children given IVIg were hospitalized for 1.99± 0.83 days, while those given Anti-D were hospitalized for 1.93± 1.15 days. Fewer adverse effects (headache, vomiting, chills) were observed in children given Anti-D. Seven of ten patients given Anti-D experienced a decrease in hemoglobin concentration (mean 0.89 ± 0.48 g/dL; range 0.1 to 1.4 g/dL). In this analysis, Anti-D was as effective with fewer adverse effects when compared to IVIg for the treatment of acute ITP in children. Randomized, controlled trials are needed to establish the role of Anti-D in the treatment of acute ITP in children.