The treatment of chronic idiopathic thrombocytopenia with anti-D (Rho) immunoglobulin: its effectiveness, safety and mechanism of action

Abstract

Twenty-three courses of i.v. anti-D (Rho) immunoglobulin were administered to 13 Rh D-positive patients with chronic idiopathic thrombocytopenia (ITP). Clinically significant responses were seen in a proportion of patients treated with 500-2500 i.u. anti-D, but all those treated with 12,500 i.u. (180 i.u./kg) responded. Patients refractory to other forms of treatment responded well to anti-D, and previous splenectomy did not influence the clinical response. No adverse reactions were observed. The anti-D response was preceded by a lag period of 3-16 days and was maintained for 14-145 days. Platelet-associated IgG was increased after treatment, due to improved survival of immunosensitized platelets or platelet Fc receptor binding of high molecular weight IgG in the therapeutic material. There was no clinical or biochemical evidence of haemolysis. The erythrocyte direct Coombs' test remained positive for 3-45 days, and histological examination of splenic material showed no erythrophagocytosis. We conclude that anti-D (Rho) immunoglobulin is a safe and effective treatment for chronic ITP and that the therapeutic dose is now established in standardized units. The mechanism of action appears to be complex and is probably not due to macrophage Fc receptor blockade with immunosensitized red cells.

Autoimmune thrombocytopenia: Current treatment options in adults with a focus on novel drugs

“…27 Several studies have confirmed that anti-RhD is an effective and safe treatment option in ITP. 28,29 Moreover, similar to IVIG, this agent has the benefit of inducing a more rapid increase in platelet count than oral corticosteroids; however, it also requires intravenous infusion and usually demonstrates a infection did not influence the response to the treatment among the adults. The response rate in the adult group was 72% and was significantly higher in patients with hemoglobin levels ≥12 g/dL.…”

Prevention of D sensitization after mismatched transfusion of blood components: toward optimal use of RhIG

“…These studies provide valuable information about RhIG in mismatched transfusion inasmuch as they illustrate treatment tolerability. The early studies involved a wide range of doses and administration regimens 48‐53 . Based on earlier work to establish PLT‐sparing efficacy, the total RhIG doses given in these studies were relatively high compared to those used in D‐mismatched transfusion.…”

“…The early studies involved a wide range of doses and administration regimens. [48][49][50][51][52][53] Based on earlier work to establish PLTsparing efficacy, the total RhIG doses given in these studies were relatively high compared to those used in D-mismatched transfusion. Experiences with these doses are therefore likely to exaggerate the adverse events associated with RhIG administration.…”

Problems Associated With Passively Transfused Blood Group Alloantibodies

“…88 "" 93 Other investigators reported similar results. [94][95][96][97][98][99][100] The same approach has been used for treating HIV-related thrombocytopenia in D+ patients. 98 < 10°-i°3 In about 25% of D+ patients, Rh(D) IVIgG therapy does not seem effective.…”