High-dose intravenous immunoglobulin in the treatment of autoimmune haemolytic anaemia

Abstract

Conventional doses of intravenous immunoglobulin (i.v. Ig) (0.4 g/kg/day for 5 days) commonly produce a remission in immune thrombocytopenia (ITP) but have only rarely been successful in autoimmune haemolytic anaemia (AIHA). There are a few reports of higher doses of i.v. Ig being more effective in AIHA. We have treated two patients with AIHA with high-dose i.v. Ig (0.5 g/kg/day for 5 days). In one patient with an associated ITP a prompt rise in platelet count but no change in Hb concentration occurred. The second patient with AIHA associated with chronic lymphatic leukaemia showed a prompt response, with a rise in Hb concentration and fall in plasma bilirubin. The poor response to i.v. Ig seen in AIHA may be related to the expansion of the reticulo-endothelial system seen in AIHA but not ITP. Clearance of antibody-coated red cells and platelets may occur at different rates and/or sites in the reticulo-endothelial system and this may account for the differential response seen in case 1. Higher doses of i.v. Ig, in the range 0.5-1 g/kg/day for 5 days, are required in AIHA, particularly if significant splenomegaly is present, and may be effective in refractory cases.

Efficacy of low dose intravenous immunoglobulins for post-splenectomy treatment of autoimmune haemolytic anaemia in a patient with hereditary spherocytosis

“…Splenectomy represents the only treatment option for hereditary spherocytosis, whilst it is effective in 81% of patients with autoimmune haemolytic anaemia unresponsive to steroids ( Zupanska et al 1981 ). Controversy exists as regards IV IgG efficacy and dosage in autoimmune haemolytic anaemia ( Bussel et al 1983 ; McIntyre et al 1985 ; Mueller‐Eckardt et al 1985 ; Oda et al 1985 ; Leickly & Buckley 1987; Majer & Hyde 1988; Blanchette et al 1992 ). Varying doses of IV IgG might be required to saturate Fc phagocyte receptors in subjects with different degrees of reticulo‐endothelial system expansion.…”

Indications and safety of intravenous and subcutaneous immunoglobulin therapy

“…Cases of auto immune hemolytic anemia [175][176][177] and autoimmune neutropenia [178] have also been treated successfully with IVIg, but without more evidence this therapy should be regarded as experimental.…”

High-Dose Intravenous Immunoglobulin in the Management of Autoimmune Hemolytic Anemia Complicating Thalassemia major

“…Three of our patients achieved remission with the standard dose of 2 g/kg. Higher doses in the order of 2.5-5 g/kg have been used by others [18] in autoim mune hemolytic anemia and could be administered also in thalassemic patients who do not achieve remis sion with small doses.…”