Thromboembolic events are not uncommon in patients with immune thrombocytopenia

Thachil, Jecko; Callaghan, Therese; Martlew, Vanessa

doi:10.1111/j.1365-2141.2010.08234.x

Cited by 25 publications

(10 citation statements)

References 10 publications

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“…Since our findings suggest that intact anti-GPIbα antibodies might aggravate the severity of thrombosis, manufacturers of this potential therapy may need to take this into consideration and avoid this adverse effect by using monovalent Fab or Fv antibody fragments. In addition, since thromboembolic events occur in approximately 5% of ITP patients (70)(71)(72), it may be worthwhile to address whether these patients have anti-GPIbα antibodies.…”

Section: Discussionmentioning

confidence: 99%

The maternal immune response to fetal platelet GPIbα causes frequent miscarriage in mice that can be prevented by intravenous IgG and anti-FcRn therapies

et al. 2011

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Fetal and neonatal immune thrombocytopenia (FNIT) is a severe bleeding disorder caused by maternal antibody-mediated destruction of fetal/neonatal platelets. It is the most common cause of severe thrombocytopenia in neonates, but the frequency of FNIT-related miscarriage is unknown, and the mechanism(s) underlying fetal mortality have not been explored. Furthermore, although platelet αIIbβ3 integrin and GPIbα are the major antibody targets in immune thrombocytopenia, the reported incidence of anti-GPIbα-mediated FNIT is rare. Here, we developed mouse models of FNIT mediated by antibodies specific for GPIbα and β3 integrin and compared their pathogenesis. We found, unexpectedly, that miscarriage occurred in the majority of pregnancies in our model of anti-GPIbα-mediated FNIT, which was far more frequent than in anti-β3-mediated FNIT. Dams with anti-GPIbα antibodies exhibited extensive fibrin deposition and apoptosis/necrosis in their placentas, which severely impaired placental function. Furthermore, anti-GPIbα (but not anti-β3) antiserum activated platelets and enhanced fibrin formation in vitro and thrombus formation in vivo. Importantly, treatment with either intravenous IgG or a monoclonal antibody specific for the neonatal Fc receptor efficiently prevented anti-GPIbα-mediated FNIT. Thus, the maternal immune response to fetal GPIbα causes what we believe to be a previously unidentified, nonclassical FNIT (i.e., spontaneous miscarriage but not neonatal bleeding) in mice. These results suggest that a similar pathology may have masked the severity and frequency of human anti-GPIbα-mediated FNIT, but also point to possible therapeutic interventions.

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Section: Discussionmentioning

confidence: 99%

The maternal immune response to fetal platelet GPIbα causes frequent miscarriage in mice that can be prevented by intravenous IgG and anti-FcRn therapies

et al. 2011

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“…To reduce the risk for thrombocytosis during maintenance, 17 dose was tapered to 300 U/kg every other day when platelet counts exceeded 50 3 10 9 /L, and treatment discontinued when platelet counts rose above 100 3 10 9 /L. After delivery, the dose was further tapered to 300 U/kg every week, and adjusted if the platelet count could not maintain above 30 …”

Section: Methodsmentioning

confidence: 99%

A novel recombinant human thrombopoietin therapy for the management of immune thrombocytopenia in pregnancy

Kong

Qin

Xiao

et al. 2017

Blood

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“…Moreover, the infusion may have a procoagulant activity via activated factor XI [12, 17]. Last, the IVIg infusion may alter cytokine synthesis, especially that of the vasoconstrictive cytokines, resulting in arterial vasospasm [12, 17–19].…”

Section: Discussionmentioning

confidence: 99%

A serious thrombotic event in a patient with immune thrombocytopenia requiring intravenous immunoglobulin: a case report

Rungjirajittranon

Owattanapanich

2019

J Med Case Reports

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BackgroundImmune thrombocytopenia is an acquired autoimmune disease. Recently, there has been evidence of thrombotic risk in patients with immune thrombocytopenia, but the mechanism is still inconclusive. Intravenous immunoglobulin infusion therapy is considered an efficient treatment; however, it still is associated with adverse events of fever, chills, and hypotension, as well as serious complications such as thrombosis. We report a case a patient with relapsed immune thrombocytopenia who developed ischemic stroke after an intravenous immunoglobulin infusion.Case presentationA 49-year-old Thai woman with relapsed/refractory immune thrombocytopenia came to our hospital with a large hematoma at the right buttock, and her platelet was decreased to 3 × 109/L. She was admitted to our hospital for intravenous immunoglobulin administration. One hour after completion of intravenous immunoglobulin infusion, the patient’s sister complained that the patient was unconscious and could not move both legs and arms. Emergency computed tomography of the brain showed no abnormal findings, such as brain edema, intracranial hemorrhage, or infarction. One day later, repeat computed tomography of the brain displayed extensive acute ischemic changes and loss of gray-white differentiation of bilateral cerebral hemispheres.ConclusionsWe performed an extensive literature review to determine the possible causes of serious thrombotic events in immune thrombocytopenia between the predictive factors of the disease and intravenous immunoglobulin. Although intravenous immunoglobulin is an effective treatment, thrombotic complications can occur. We emphasize that in patients with atherosclerosis risk factors or thrombophilia, the appropriateness of administering an intravenous immunoglobulin infusion should be carefully evaluated.Electronic supplementary materialThe online version of this article (10.1186/s13256-018-1955-x) contains supplementary material, which is available to authorized users.

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Thromboembolic events are not uncommon in patients with immune thrombocytopenia

Cited by 25 publications

References 10 publications

The maternal immune response to fetal platelet GPIbα causes frequent miscarriage in mice that can be prevented by intravenous IgG and anti-FcRn therapies

The maternal immune response to fetal platelet GPIbα causes frequent miscarriage in mice that can be prevented by intravenous IgG and anti-FcRn therapies

A novel recombinant human thrombopoietin therapy for the management of immune thrombocytopenia in pregnancy

A serious thrombotic event in a patient with immune thrombocytopenia requiring intravenous immunoglobulin: a case report

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