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Abstract

Heparin-induced thrombocytopenia (HIT) is a common drug induced autoimmune condition. The thrombocytopenia is caused in most cases by an antibody directed against the complex PF4/heparin. Recently, we have induced an experimental model of HIT by idiotypic manipulation. To confirm further the idiotypic involvement of HIT, we have treated successfully three patients with HIT with high-dose intravenous gamma-globulin (IVIG). Our three patients joint other two cases previously reported who were treated with IVIG and point to the efficacy of this type of therapy with minimal side effects. IVIG suppression of the anti-PF4/heparin autoantibody may support the idiotypic etiology of HIT.

Intravenous Immune Globulin (IVIG) for Treatment of Autoimmune Heparin-Induced Thrombocytopenia: A Systematic Review

“…45,46,[50][51][52][53][54] Similarities to data in Table 2 include median platelet nadir (18 × 10 9 /L) and that most patients were postsurgical (commonly postorthopedic and postcardiac surgery). 45,46,[50][51][52][53][54] Mean age (57 years old) was lower than in the patients in Table 2. 45,46,[50][51][52][53][54] Approximately 46% of patients presented with venous thrombosis at HIT diagnosis, and 15% had major bleeding.…”

“…46,49,52,53 Betrosian et al 51 and Gul et al 54 reported a positive ELISA but did not report an OD value. Winder et al 50 reported 3 HIT cases with an immunoassay (OD < 2), although each of the patients had an activation assay completed by platelet-rich plasma activation assay. This assay test has become obsolete and the results questioned because of its lower sensitivity.…”

“…There were 15 additional cases (10 articles; additional to the cases identified in Tables 2 and 3) published describing IVIG use for treatment of suspected HIT. [45][46][47][48][49][50][51][52][53][54] Two cases were published in German. 47,48 In 1989, Frame et al reported the first case using IVIG for suspected HIT.…”

“…[45][46][47][48][49][50][51][52][53][54] Although the cases did not meet current review criteria, the 13 cases with data available had similar platelet responses to IVIG as the cases reported in Table 2. 45,46,[50][51][52][53][54] Similarities to data in Table 2 include median platelet nadir (18 × 10 9 /L) and that most patients were postsurgical (commonly postorthopedic and postcardiac surgery). 45,46,[50][51][52][53][54] Mean age (57 years old) was lower than in the patients in Table 2.…”

“…45,46,[50][51][52][53][54] Approximately 46% of patients presented with venous thrombosis at HIT diagnosis, and 15% had major bleeding. 45,46,[50][51][52][53][54] Diagnosis was in question for several cases in this literature. In addition, some of the patients had concurrent immune conditions such as systemic lupus erythematosus and HELPP syndrome (hemolysis, elevated liver enzymes, low platelet count).…”