Treatment of immune-mediated thrombocytopenia purpura with concurrent intravenous immunoglobulin and platelet transfusion: A retrospective review of 40 patients

2008 ◽  
Vol 83 (2) ◽  
pp. 122-125 ◽  
Author(s):  
Joseph E. Spahr ◽  
George M. Rodgers
Keyword(s):  
Intravenous Immunoglobulin ◽  
Retrospective Review ◽  
Platelet Transfusion ◽  
Immune Mediated

scholarly journals Severe Menorrhagia and Thrombocytopenia in a Patient with Pseudohypoparathyroidism

2021 ◽  
Vol 5 (2) ◽  
pp. 01-04
Author(s):  
Lily Suh
Keyword(s):  
Intravenous Immunoglobulin ◽  
Platelet Transfusion ◽  
Severe Anemia ◽  
Platelet Dysfunction ◽  
Platelet Destruction ◽  
Platelet Counts ◽  
Immune Mediated ◽  
History Of ◽  
Pseudohypoparathyroidism Ia

A 15-year-old female with a history of hypothyroidism presented with severe anemia and thrombocytopenia in the setting of prolonged menses. After further evaluation, she was diagnosed with pseudohypoparathyroidism Ia (PHPIa). Her symptoms improved after starting medications and receiving a platelet transfusion, but a few weeks later she returned with complaints of bleeding and dizziness and was found to be thrombocytopenic once again. Her platelet counts improved after administration of intravenous immunoglobulin (IVIG), leading us to believe she has a combined immune mediated platelet destruction in addition to platelet dysfunction associated with her PHPIa.

Successful treatment of infliximab-associated immune-mediated sensory polyradiculopathy with intravenous immunoglobulin

2013 ◽  
Vol 20 (11) ◽  
pp. 1618-1619 ◽  
Author(s):  
Hiroya Naruse ◽  
Yu Nagashima ◽  
Risa Maekawa ◽  
Takafumi Etoh ◽  
Ayumi Hida ◽  
...  
Keyword(s):  
Intravenous Immunoglobulin ◽  
Successful Treatment ◽  
Immune Mediated

Mechanisms of Action of Intravenous Immunoglobulin (IVIg) in Immune-Mediated Diseases

1999 ◽  
pp. 383-394
Author(s):  
K. A. Nagendra Prasad ◽  
Michel D. Kazatchkine ◽  
Srinivas V. Kaveri
Keyword(s):  
Intravenous Immunoglobulin ◽  
Mechanisms Of Action ◽  
Immune Mediated

Treatment of Immune-Mediated Thrombocytopenia Purpura with Concurrent IVIg and Platelet Transfusion: A Retrospective Review of 40 Patients.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3972-3972
Author(s):  
Joseph E. Spahr ◽  
Neeraj Agarwal ◽  
George M. Rodgers
Keyword(s):  
Platelet Count ◽  
Side Effects ◽  
Retrospective Review ◽  
Combined Treatment ◽  
Age Groups ◽  
Optimal Dose ◽  
Active Bleeding ◽  
Bleeding Complications ◽  
Platelet Counts ◽  
Immune Mediated

Abstract Introduction: In January 2000, two patients with severe Immune-Mediated Thrombocytopenia (ITP) at our institution were successfully treated with prolonged infusions of IVIg and platelets. The dose of IVIg was 1 g/kg given by continuous infusion over 24 hours with concurrent platelets (1 pheresis unit every 8 hours). Based on these preliminary results, we evaluated this protocol in a larger series of 40 ITP patients. Methods: We performed an IRB-approved retrospective review of adult hospitalized patients with ITP treated with this regimen from January 2000 - December 2005. Patients with clinically significant thrombocytopenia and either active bleeding, need for anticoagulation, or requirement for a surgical procedure received the combined treatment. The subjects received IVIg and platelets as described above. Additional treatments, such as steroids, immunosupressives, or rituximab, as well as splenectomy were utilized at the discretion of the hematologist overseeing their care. Results: The average age of patients treated was 52 years. The majority of patients ranged from 20–80 years old, but 12.5% were older than 80 years. The average pretreatment platelet count was 10,000/μl, with an increase to 55,000/μl after 24 hours, and 69,000/μl after 48 hours. By 72 hours, the average platelet count had begun to decline, although the platelet count remained at an acceptable level (58,200/μl). After 24 hours, 62.7% of patients had a platelet count > 50,000/μl. Bleeding was controlled initially in all patients, and those requiring a procedure experienced no bleeding complications. Over half of the patients (52.5%) required additional treatments for recurrent or refractory ITP, and 32.5% of the patients underwent splenectomy. Six of the 21 patients requiring later retreatment (29%) received IVIg and platelets again in a similar fashion. The average retreatment platelet counts after 24 and 48 hours were 53,000/μl and 49,000/μl respectively, with clinical improvement in bleeding in all patients. No side effects of the combined treatment were noted. The response rates for the 3 IVIg products used were similar. Discussion: For ITP, IVIg and platelets are considered to be first line treatment for patients with very low platelet counts, active bleeding, or those requiring urgent procedures. There is limited literature on the optimal dose and schedule for administration of IVIg and platelets. Our approach for administration of IVIg and platelets concurrently was associated with minimal side effects, resolution of bleeding, ability to safely undergo procedures, and rapid restoration of adequate platelet counts. Additionally, elderly patients had equivalent benefit with no increased side effects, indicating that this regimen is appropriate and safe for patients of all age groups.

scholarly journals Clinical Responses to Rituximab in a Case of Neuroblastoma with Refractory Opsoclonus Myoclonus Ataxia Syndrome

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Samin Alavi ◽  
Ali Kord Valeshabad ◽  
Borhan Moradveisi ◽  
Ali Aminasnafi ◽  
Mohammad Taghi Arzanian
Keyword(s):  
Eye Movements ◽  
Intravenous Immunoglobulin ◽  
Severity Score ◽  
Adrenocorticotropic Hormone ◽  
Efficacy And Safety ◽  
Imaging Studies ◽  
Immune Mediated ◽  
Clinical Responses ◽  
Ataxia Syndrome ◽  
Refractory Case

Opsoclonus myoclonus ataxia syndrome (OMS) is a rare neurologic syndrome. In a high proportion of children, it is associated with neuroblastoma. The etiology of this condition is thought to be immune mediated. In children, immunotherapy with conventional treatments such as corticosteroids, intravenous immunoglobulin, adrenocorticotropic hormone, and even antiepileptic drugs has been tried. Recently rituximab has been used safely for refractory OMS in children with neuroblastoma. Our patient was a 3.5-year-old girl referred for ataxia and dancing eye movements starting since 1.5 years ago. She was diagnosed with neuroblastoma on imaging studies on admission. The OMS was refractory to surgical resection, chemotherapy, corticosteroids, and intravenous immunoglobulin. Patient received rituximab simultaneously with chemotherapy. The total severity score decreased by 61.1% after rituximab. Patient's ataxia markedly improved that she was able to walk independently after 6 months. Our case confirmed the clinical efficacy and safety of rituximab in a refractory case of OMS.

Megakaryocyte impairment by eptifibatide-induced antibodies causes prolonged thrombocytopenia

Blood ◽  
2009 ◽  
Vol 114 (6) ◽  
pp. 1250-1253 ◽  
Author(s):  
Andreas Greinacher ◽  
Birgitt Fuerll ◽  
Heike Zinke ◽  
Bernd Müllejans ◽  
William Krüger ◽  
...  
Keyword(s):  
Acute Coronary Syndromes ◽  
Immune Thrombocytopenia ◽  
Platelet Transfusion ◽  
Bone Marrow Examination ◽  
Enzyme Linked Immunosorbent Assay ◽  
Specific Enzyme ◽  
Autoimmune Thrombocytopenia ◽  
Coronary Syndrome ◽  
Immune Mediated ◽  
Coronary Syndromes

Abstract Glycoprotein (GP) IIbIIIa inhibitors are used in the treatment of acute coronary syndromes. Transient immune-mediated acute thrombocytopenia is a recognized side effect of GPIIbIIIa inhibitors. We provide evidence that GPIIbIIIa inhibitor-induced antibodies can affect megakaryocytes in the presence of eptifibatide. In a patient with acute coronary syndrome, acute thrombocytopenia occurred after a second exposure to eptifibatide 20 days after the initial treatment. Despite the short half-life of eptifibatide (t1/2 = 2 hours), thrombocytopenia less than 5 × 109/L and gastrointestinal and skin hemorrhage persisted for 4 days. Glycoprotein-specific enzyme-linked immunosorbent assay showed eptifibatide-dependent, GPIIbIIIa-specific antibodies. Bone marrow examination showed predominance of early megakaryocyte stages, and platelet transfusion resulted in an abrupt platelet count increase. Viability of cultured cord blood–derived megakaryocytes was reduced in the presence of eptifibatide and patient IgG fraction. These findings can be explained by impaired megakaryocytopoiesis complicating anti-GPIIbIIIa antibody-mediated immune thrombocytopenia. This mechanism may also apply to some patients with autoimmune thrombocytopenia.

Incidence and natural history of intravenous immunoglobulin-induced aseptic meningitis: a retrospective review at a single tertiary care center

Transfusion ◽  
2015 ◽  
Vol 55 (11) ◽  
pp. 2597-2605 ◽  
Author(s):  
Vighnesh Bharath ◽  
Kathleen Eckert ◽  
Matthew Kang ◽  
Ian H. Chin-Yee ◽  
Cyrus C. Hsia
Keyword(s):  
Natural History ◽  
Intravenous Immunoglobulin ◽  
Aseptic Meningitis ◽  
Retrospective Review ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
History Of

Inhibition of maturation and function of dendritic cells by intravenous immunoglobulin

Blood ◽  
2003 ◽  
Vol 101 (2) ◽  
pp. 758-765 ◽  
Author(s):  
Jagadeesh Bayry ◽  
Sébastien Lacroix-Desmazes ◽  
Cedric Carbonneil ◽  
Namita Misra ◽  
Vladimira Donkova ◽  
...  
Keyword(s):  
Dendritic Cells ◽  
T Cell ◽  
Autoimmune Diseases ◽  
Intravenous Immunoglobulin ◽  
T Cell Activation ◽  
Cell Activation ◽  
Cell Activity ◽  
Interleukin 12 ◽  
Immune Mediated ◽  
And Function

Normal immunoglobulin G for therapeutic use (intravenous immunoglobulin [IVIg]) is used in an increasing number of immune-mediated conditions, including acute and chronic/relapsing autoimmune diseases, transplantation, and systemic inflammatory disorders. Several mutually nonexclusive mechanisms of action account for the immunoregulatory effects of IVIg. Although IVIg inhibits T-cell proliferation and T-cell cytokine production, it is unclear whether these effects are directly dependent on the effects of IVIg on T cells or they are dependent through the inhibition of antigen-presenting cell activity. Here, we examined the effects of IVIg on differentiation, maturation, and function of dendritic cells (DCs). We show that IVIg inhibits the differentiation and maturation of DCs in vitro and abrogates the capacity of mature DC to secrete interleukin-12 (IL-12) on activation while enhancing IL-10 production. IVIg-induced down-regulation of costimulatory molecules associated with modulation of cytokine secretion resulted in the inhibition of autoreactive and alloreactive T-cell activation and proliferation. Modulation of DC maturation and function by IVIg is of potential relevance to its immunomodulatory effects in controlling specific immune responses in autoimmune diseases, transplantation, and other immune-mediated conditions.

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