Neutropenia as a Complication of High-Dose Intravenous Immunoglobulin Therapy in Adult Patients With Neuroimmunologic Disorders

Abstract

To investigate clinical aspects of the neutropenia induced by high-dose intravenous immunoglobulin therapy (IVIG) we performed serial hematology, including differentiation of white blood cells (WBC), before and after 22 instances of IVIG in 16 patients with neuroimmunologic disorders. WBC and neutrophils showed a significant decrease with a nadir 2 days after IVIG, but returned to previous values by 14 days with no treatment except in 2 cases. No patient showed any infectious complication. Both WBC and neutrophils were significantly decreased in cases without corticosteroid therapy but not in those with medication. In nine instances (4 with and 5 without corticosteroid treatment), CD11b and CD16 on neutrophils were investigated using flow cytometry. In 3 of 5 instances without corticosteroid treatment the expression of CD11b was decreased after IVIG, while no change was detected in CD16. There was no difference in either CD11b or CD16 between before and after IVIG in instances with corticosteroid therapy. Neutropenia commonly and transiently develops just after IVIG, and can be prevented by corticosteroid pretreatment. Circulating neutrophils might bind to the vascular wall mainly with the involvement of CD11b and migrate into a storage pool, resulting in an apparent neutropenia after IVIG.

Neutropenia Following Intravenous Immunoglobulin Administration in a Patient with Multifocal Motor Neuropathy with Conduction Block

“…In the present case, neutropenia developed on day 2 after initiation of infusion and reached nadir on day 4. In line with previous reports [8,10], leukocyte counts of our patient returned to baseline after 2 weeks without any complication.…”

“…IgG aggregates with immune-complex-like activity was suggested as the cause of transient neutropenia by some researchers [9,14]. Matsuda et al [10] focused on two factors located in the surface of neutrophils: a complement receptor CD11b and an Fc gamma receptor CD16. Of the two surface antigens, only the level of expression of CD11b was found to be decreased after IVIG.…”

“…First, Matsuda et al revealed that coadministration of corticosteroids prevented neutropenia following IVIG infusion [10], but that may not be appropriate for patients with MMNCB. Second, subcutaneous immunoglobulin (SCIG) may be an alternative [18,19].…”

Immunologic and functional evidence for anti–Siglec-9 autoantibodies in intravenous immunoglobulin preparations

“…On the other hand, the reason for IVIg-induced neutropenia in some patients remains obscure, [31][32][33][34][35] and the results of our study may also provide a potential mechanism of this unwanted effect of IVIg therapy. In particular, under inflammatory conditions, IVIg-induced neutropenia may be mediated by natural anti-Siglec-9 autoantibodies.…”

IVIG for Thymoma-Associated Pseudo-Obstruction: Report of Successful Treatment

“…He was discharged on postoperative day 23 with instructions to continue pyridostigmine but discontinued it as he had minimal symptoms. Minor complications of IVIG included transient leukopenia and autoimmune thyroiditis [11] . Neither required therapy and both resolved spontaneously.…”