Puerperal streptococcal toxic shock syndrome treated with recombinant human activated protein C and intravenous immunoglobulin

Al-Rawi, S.; Woodward, Lianne J.; Knight, J.

doi:10.1016/j.ijoa.2008.10.003

Cited by 10 publications

(5 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We identified 20 reports in the literature describing 27 cases of acute HIT that were treated with IVIG (Table ) . Two cases of putative HIT were excluded, one because the clinical picture was not sufficiently specific for HIT, and no testing for HIT antibodies was performed, and the other because IVIG was given for treatment of Group A puerperal toxic shock syndrome, with associated severe sepsis‐associated thrombocytopenia and with possible HIT only developing several days later, with prompt PLT count recovery after stopping heparin; thus, the impact of IVIG administration, if any, on PLT count changes in HIT could not be ascertained . However, neither case indicated any thrombotic or other adverse consequences of IVIG administration, and so including these cases would not have altered our conclusions.…”

Section: Resultsmentioning

confidence: 99%

Autoimmune heparin‐induced thrombocytopenia and venous limb gangrene after aortic dissection repair: in vitro and in vivo effects of intravenous immunoglobulin

et al. 2019

View full text Add to dashboard Cite

BACKGROUND: Heparin-induced thrombocytopenia (HIT) is a prothrombotic disorder characterized by heparindependent antibodies that activate platelets (PLTs) via PLT FcγIIa receptors. "Autoimmune" HIT (aHIT) indicates a HIT subset where thrombocytopenia progresses or persists despite stopping heparin; aHIT sera activate PLTs strongly even in the absence of heparin (heparin-independent PLTactivating properties). Affected patients are at risk of severe complications, including dual macro-and microvascular thrombosis leading to venous limb gangrene. High-dose intravenous immunoglobulin (IVIG) offers an approach to interrupt heparin-independent PLT-activating effects of aHIT antibodies. CASE REPORT:A 78-year-old male who underwent cardiopulmonary bypass for aortic dissection developed aHIT, disseminated intravascular coagulation, and deep vein thrombosis; progression to venous limb gangrene occurred during partial thromboplastin time (PTT)-adjusted bivalirudin infusion (underdosing from "PTT confounding"). Thrombocytopenia recovered with high-dose IVIG, although the PLT count increase began only after the third dose of a 5-day IVIG regimen (0.4 g/kg/day × 5 days). We reviewed case reports and case series of IVIG for treating HIT, focusing on various IVIG dosing regimens used. RESULTS: Patient serum-induced PLT activation wasinhibited in vitro by IVIG in a dose-dependent fashion; inhibition of PLT activation by IVIG was much more marked in the absence of heparin versus the presence of heparin (0.2 U/mL). Our literature review indicated 1 g/kg × 2 IVIG dosing as most common for treating HIT, usually associated with rapid PLT count recovery. CONCLUSION:Our clinical and laboratory observations support dose-dependent efficacy of IVIG for decreasing PLT activation and thus correcting thrombocytopenia in aHIT. Our case experience and literature review suggests dosing of 1 g/kg IVIG × 2 for patients with severe aHIT. ABBREVIATIONS: aHIT = autoimmune heparin-induced thrombocytopenia; DIC = disseminated intravascular coagulation; DVT = deep vein thrombosis; HIT = heparin-induced thrombocytopenia; ITP = idiopathic thrombocytopenic purpura; PE = pulmonary embolism; PF4 = platelet factor 4; POD = postoperative day; PTT(s) = partial thromboplastin time(s); SRA = serotonin release assay; UFH = unfractionated heparin. From the

show abstract

Section: Resultsmentioning

confidence: 99%

Autoimmune heparin‐induced thrombocytopenia and venous limb gangrene after aortic dissection repair: in vitro and in vivo effects of intravenous immunoglobulin

et al. 2019

View full text Add to dashboard Cite

show abstract

“…I identified 27 reports describing 35 cases of acute HIT that were treated with IVIg . Two additional cases of putative HIT [64,65] were excluded, one because the clinical picture did not appear to support a diagnosis of HIT, and no laboratory testing for HIT antibodies was performed [64], and the other because IVIG was given for treatment of preceding puerperal toxic shock syndrome, rather than for treatment of subsequent HIT [65]. Neither case indicated that any adverse events occurred post-IVIG administration, and so the inclusion of these cases would not have altered my conclusions.…”

Section: Literature Identifiedmentioning

confidence: 99%

High-dose intravenous immunoglobulin for the treatment and prevention of heparin-induced thrombocytopenia: a review

Warkentin

2019

Expert Review of Hematology

136

173

View full text Add to dashboard Cite

Introduction: Heparin-induced thrombocytopenia (HIT) is known for its strong association with thrombosis and distinct pathogenesis involving anti-PF4/polyanion antibodies that activate platelets strongly through clustering of platelet FcγIIa receptors. Autoimmune HIT (aHIT) refers to a subgroup of patients whose HIT antibodies have both heparin-dependent and heparin-independent platelet-activating properties. aHIT patients have atypical clinical presentations including delayed-onset HIT, persisting (refractory) HIT, heparin 'flush' HIT, fondaparinux-associated HIT, severe thrombocytopenia (platelet count <20 × 10 9 /L) with overt disseminated intravascular coagulation, and spontaneous HIT syndrome. Areas covered: This article reviews all available literature describing the use of high-dose intravenous immunoglobulin (IVIG) as an adjunct treatment to anticoagulation in HIT patients. IVIG is usually effective in interrupting platelet activation by aHIT antibodies, manifesting as a rapid platelet count increase after starting IVIG (usual dose, 1g/kg × 2 days). Experience to date suggests IVIG de-escalates HIT and likely reduces thrombotic risk. A new case of aHIT successfully treated with IVIG is presented. Use of IVIG to prevent acute HIT with planned heparin reexposure in antibody-positive patients is also discussed. Expert opinion: High-dose IVIG appears to rapidly inhibit HIT antibody-induced platelet activation and has the potential to become an important treatment adjunct for HIT, particularly in patients with aHIT.

show abstract

“…Se encontraron 6 artículos relacionados directamente con el uso de la inmunoglobulina en el embarazo, 1 artículo de revisión (20), 2 reportes de caso (21,22) y tres guías de diagnóstico y manejo (14, 23,24).…”

Section: Resultsunclassified

“…Entre otros estudios, Al Rawi reporta el caso en el Reino Unido de una paciente de 25 años, quien 12 horas después de un parto pretérmino de 32 semanas desarrolla sepsis por estreptococo beta-hemolítico y es llevada a la UCI; debido a la poca respuesta al tratamiento, se le inicia como terapia adyuvante proteína C activada e IVIG, no se especifica la dosis ni el tiempo de esta terapia, pero reportan que al segundo día la condición de la paciente comienza a estabilizarse, no se registran efectos adversos de estos medicamentos y concluyen que el uso temprano de IVIG y proteína C activada puede conducir a buenos resultados en la sepsis materna (22).…”

Section: Resultsunclassified

Uso de inmunoglobulinas intravenosas en una paciente obstétrica con choque séptico: reporte de caso y revisión de la literatura

Cuero-Vidal

Moreno-Sánchez

Torres-Bejarano

et al. 2016

Rev. Colomb. Obstet. Ginecol.

View full text Add to dashboard Cite

Objetivo: reportar el caso de una paciente obstétrica que desarrolló un shock séptico secundario a una infección gastrointestinal y el uso de inmunoglobulina endovenosa (IVIG) como terapia coadyuvante en pacientes obstétricas con sepsis, y hacer una revisión de la literatura publicada del uso de inmunoglobulinas en shock séptico con énfasis en su uso en el embarazo.Materiales y métodos: se presenta el caso de una paciente con embarazo de 36 semanas, quien presentó un choque séptico secundario a una infección gastrointestinal y progresó con falla orgánica multisistémica. En vista de la pobre respuesta al tratamiento instaurado se inició terapia coadyuvante con inmunoglobulina enriquecida en IgM con una buena respuesta. Se realizó una búsqueda de la literatura en la bases de datos de Medline vía PubMed, Direct Sciencie, Biblioteca Cochrane y SciELO utilizando las palabras clave del DeCS como inmunoglobulina endovenosa y sepsis en embarazo.Resultados: se encontraron 6 artículos relacionados directamente con el uso de IVIG en sepsis en el embarazo, 1 revisión de tema, 2 reportes de caso y 3 guías diagnósticas y de manejo. Las inmunoglobulinas intravenosas se han utilizado con mayor frecuencia en pacientes no obstétricas en shock séptico como terapia coadyuvante a una pobre respuesta al tratamiento, especialmente en infección por estreptococos y estafilococos.Conclusión: las inmunoglobulinas intravenosas podrían ser una alternativa como coadyuvante en manejo de shock séptico en gestantes con pobre respuesta al tratamiento convencional. Se necesitan estudios analíticos que incluyan gestantes para confirmar estos hallazgos.

show abstract

Puerperal streptococcal toxic shock syndrome treated with recombinant human activated protein C and intravenous immunoglobulin

Cited by 10 publications

References 11 publications

Autoimmune heparin‐induced thrombocytopenia and venous limb gangrene after aortic dissection repair: in vitro and in vivo effects of intravenous immunoglobulin

Autoimmune heparin‐induced thrombocytopenia and venous limb gangrene after aortic dissection repair: in vitro and in vivo effects of intravenous immunoglobulin

High-dose intravenous immunoglobulin for the treatment and prevention of heparin-induced thrombocytopenia: a review

Uso de inmunoglobulinas intravenosas en una paciente obstétrica con choque séptico: reporte de caso y revisión de la literatura

Contact Info

Product

Resources

About