Intravenous Immunoglobulin and Anti-RhD Therapy in the Management of Immune Thrombocytopenia

Cooper, Nichola

doi:10.1016/j.hoc.2009.09.002

Cited by 36 publications

(22 citation statements)

References 57 publications

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“…Should investment in IVIG as a treatment option for preterms with neonatal sepsis be decided, it is better started as a replacement to improve outcome and minimize complications. Use of IVIG in ITP was definitely beneficial when compared to steroids but has definite indications, in patients who do not go into an immediate remission and where it is anticipated that remission may still occur and steroid-sparing agents are required 17 .…”

Section: Discussionmentioning

confidence: 99%

Pattern of intravenous immunoglobulins (IVIG) use in a pediatric intensive care facility in a resource limited setting

Galal¹

2013

Afr H. Sci.

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Background: Intravenous Immunoglobulin (IVIG) preparations are scarce biological products used for replacement or immunomodulatory effects. Guidelines have been issued by regulatory health authorities to ensure provision of the products for patients who are in severe need. Objectives: The study aimed at description of the pattern of IVIG use (label/off label indications), adverse effects observed, reason for choice of IVIG among other modalities and efficacy in a pediatric intensive care setting. Methods: A retrospective chart review. Patients: The study included 45 cases admitted from 2008 through 2011 in a Pediatric Intensive Care Unit (PICU) of a tertiary referral pediatric hospital. Results: The clinical diagnoses included neurology (35%), neonatology (16%), hematology (11%), autoimmune disorders (11%) immunodeficiency disorders (11%), infections other than neonatal sepsis (9%) and cardiology (6.5 %). The indications for IVIG use had an Evidence category Ia / Ib in 62 % of cases whereas the other 38 % had level II and III evidence. Choice of IVIG as a therapeutic option was based on failure of other treatment options to achieve response in 46.5%, lack of alternative treatment options 15.5 % and the need for urgent response in 38 %. Adverse events, duration and doses are reported. Conclusion: IVIG use is governed by availability of alternative options and the need for urgent response in critically ill children. Guidelines should be issued based on locally available treatment options and their cost effectiveness.

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Section: Discussionmentioning

confidence: 99%

Pattern of intravenous immunoglobulins (IVIG) use in a pediatric intensive care facility in a resource limited setting

Galal¹

2013

Afr H. Sci.

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“…The benefits of IVIG therapy appear to be related to the blockage of Fc receptors in the neonatal reticuloendothelial system [11]. This subsequently stops the destruction of RBCs, thus competing with anti-D sensitized neonatal erythrocytes and preventing further hemolysis [5,23]. The higher dose IVIG avoided ET; this could be attributed to its ability to block more Fc receptors which might prevent further elevation of bilirubin to exchange level.…”

Section: Discussionmentioning

confidence: 99%

Early intravenous immunoglobin (two-dose regimen) in the management of severe Rh hemolytic disease of newborn—a prospective randomized controlled trial

Elalfy

Elbarbary

Abaza³

2010

Eur J Pediatr

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Phototherapy is the standard treatment in moderately severe hemolytic disease of newborn (HDN), whereas exchange transfusion (ET) is the second line in progressive cases. Intravenous immunoglobin (IVIG) has been suggested to decrease the need for ET. We aimed at assessing the efficacy of early two-dose regimens of IVIG to avoid unnecessary ET in severe Rh HDN. The study included 90 full-term neonates with Rh incompatibility unmodified by antenatal treatment and not eligible for early ET and which were randomly assigned into one of three groups: group (I), treated by conventional method; groups IIa and IIb received IVIG once at 12 h postnatal age if PT was indicated, in a dose of 0.5 and 1 g/kg, respectively. Analysis revealed 11 neonates (22%) in the conventional group and 2 (5%) in the intervention group who administered low-dose IVIG at 12 h, while none in group IIb required exchange transfusion (p = 0.03). Mean bilirubin levels were significantly lower during the first 96 h in the intervention group compared to the conventional group (p < 0.0001). Shorter duration of phototherapy (52.8 ± 12.39 h) and hospital stay (3.25 ± 0.71 days) in the IVIG group compared to conventional group (84 ± 12.12 h and 4.72 ± 0.78 days, p < 0.0001, respectively) were observed. We conclude that IVIG administration at 12 h was effective in the treatment of severe Rh HDN; the low-dose IVIG (0.5 g/kg) was as effective as high dose (1 g/kg) in reducing the duration of phototherapy and hospital stay, but less effective in avoiding exchange transfusion.

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“…Several IVIg regimens are employed, but many clinicians prefer the convenience of a 1 gm/kg/day infusion for 1 or 2 days 10 . The activity of IVIg is mediated through several mechanisms, including modulation of Fcγ receptor expression and activity, inhibition of cytotoxic T cell activation, complement neutralization, cytokine modulation and inhibition of megakaryocyte apoptosis 91;92 . Toxicities include aseptic meningitis, fluid overload, nephrotoxicity, thrombosis, and rarely, severe hemolytic anemia.…”

Section: Therapeutic Options and Prognosismentioning

confidence: 99%

“…Anti-Rh(D) binds to the Rh(D) antigen on erythrocytes leading to clearance of antibody-coated cells and inhibiting the clearance of opsonized platelets by the reticuloendothelial system 92 ; other mechanisms including reduction in antigen specific B cell priming and modulation of Fcγ receptor and inflammatory cytokine levels may contribute. Anti-D is effective only in Rh(D) positive individuals with an intact spleen.…”

Section: Therapeutic Options and Prognosismentioning

confidence: 99%

Immune Thrombocytopenia

Kistangari

McCrae

2013

Hematology/Oncology Clinics of North America

175

157

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Immune thrombocytopenia (ITP) is a common hematologic disorder characterized by isolated thrombocytopenia. ITP presents as a primary form characterized by isolated thrombocytopenia (platelet count < 100 × 109/L) in the absence of other causes or disorders that may be associated with thrombocytopenia, or a secondary form in which immune thrombocytopenia develops in association with another disorder that is usually immune or infectious. ITP may affect individuals of all ages, with peaks during childhood and in the elderly, in whom the age specific incidence of ITP is greatest. Bleeding is the most common clinical manifestation of ITP, with the risk of bleeding and related morbidity increased in elderly patients. The pathogenesis of ITP is complex, involving alterations in humoral and cellular immunity. Thrombocytopenia is caused by antibodies that react with glycoproteins expressed on platelets and megakaryocytes (glycoprotein IIb/IIIa, Ib/IX and others), causing shortened survival of circulating platelets and impairing platelet production. Diminished numbers and function of regulatory T cells, as well as the effects of cytotoxic T cells also contribute to the pathogenesis of ITP. Corticosteroids remain the most common first line therapy for ITP, occasionally in conjunction with intravenous immunoglobulin (IVIg) and anti-Rh(D). However, these agents do not lead to durable remissions in the majority of adults with ITP, and considerable heterogeneity exists in the use of second line approaches, which may include splenectomy, Rituximab, or thrombopoietin receptor agonists (TRAs). This review summarizes the classification and diagnosis of primary and secondary ITP, as well as the pathogenesis and options for treatment. Remarkable advances in the understanding and management of ITP have been achieved over the last decade, though many questions remain.

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Intravenous Immunoglobulin and Anti-RhD Therapy in the Management of Immune Thrombocytopenia

Cited by 36 publications

References 57 publications

Pattern of intravenous immunoglobulins (IVIG) use in a pediatric intensive care facility in a resource limited setting

Pattern of intravenous immunoglobulins (IVIG) use in a pediatric intensive care facility in a resource limited setting

Early intravenous immunoglobin (two-dose regimen) in the management of severe Rh hemolytic disease of newborn—a prospective randomized controlled trial

Immune Thrombocytopenia

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