Transient Reversal of Thrombocytopenia in Idiopathic Thrombocytopenic Purpura by High-Dose Intravenous Gamma Globulin

Abstract

Since recent observations indicate that treatment with high-dose intravenous polyvalent intact immunoglobulin leads to a rapid reversal of thrombocytopenia in the idiopathic thrombocytopenic purpura (ITP) of childhood, we decided to apply this treatment to adults with ITP and to test the possibility that the effect of the immunoglobulin might be attributable to transient blockade of the reticuloendothelial system. Using sequential clearance studies of autologous 99mTc-labeled and anti-Rh(D)-sensitized erythrocytes in four adults with ITP who were treated with total doses of 1 to 1.5 g of immunoglobulin per kilogram of body weight, we found that a transient rise in platelet counts to normal levels within four to five days was accompanied by a marked temporary prolongation of the immune-particle clearance time. These data suggest that commercial intravenous immunoglobulin preparations may interfere with phagocyte Fc-receptor-mediated immune clearance. Since platelets in ITP treated with immunoglobulin were fully hemostatic, this type of therapy may allow surgical procedures to be performed safely in patients with this disease.

Hyperferritinemia as indicator for intravenous immunoglobulin treatment in reactive macrophage activation syndromes

“…There are different effects that appear to focus on attenuation of macrophage activity. Alteration of macrophage Fc-receptor (FcR) function by competitive binding of the transfused monomeric IgG and by binding of naturally occurring anti-FcR antibodies are well known [20,21]. Alteration of the activity of pro-inflammatory cytokines by naturally occurring antibodies and the capacity of IVIG to alter cytokine synthesis/release on a cellular level are further mechanisms [22][23][24].…”

Immunomodulatory action of intravenous immunoglobulin

“…There are four main lines of evidence for this: ®rstly, IVIg reduces the clearance of autologous erythrocytes coated with anti-D. 51 Secondly, IVIg treatment of patients with ITP impairs the ability of their monocytes to form rosettes with IgG-coated erythrocytes. 52 Thirdly, the in vivo effects of IVIg in ITP can be stimulated by using antibodies to FcgRIII.…”

Effect of immunoglobulin therapy on phagocytosis by polymorphonuclear leucocytes in whole blood of neonates

“…A high dose of IVIG is said to block the reticuloendothelial system [30], but its precise mechanism remains to be determined. The C2 domain is assumed to reside in the Fc fragment of the IgG molecule, which binds to reticuloendothelial Fc receptors.…”