Trends in anti‐D immune globulin for childhood immune thrombocytopenia: Usage, response rates, and adverse effects

Abstract

In 2010, the Food and Drug Administration (FDA) added a black box warning to anti-D immune globulin (Rho(D) immune globulin, anti-D) for immune thrombocytopenia (ITP) to warn of the complications related to severe hemolysis. The objective of this retrospective medical record review was to examine recent trends in anti-D use to treat ITP and rates of adverse events in a single large pediatric hematology program. Over a 7-year period, 176 (35%) of 502 ITP patients at our center received anti-D. Anti-D was the second most commonly prescribed drug for ITP from 2003 to 2010 overall and was given first most frequently (41%). Sixty-four percent of patients responded to anti-D, but 36% had adverse effects, including five patients requiring hospitalization. From 2003 to 2010, the use of anti-D as an initial therapy for ITP significantly decreased (P < 0.001). This trend preceded the 2010 FDA black box warning. In our experience, anti-D was associated with a significant number of adverse effects when used as a treatment for ITP, although none were life-threatening. Despite recent guidelines suggesting anti-D therapy for initial treatment for ITP, anti-D therapy for ITP has significantly decreased over the past 7 years.

Acute hemolysis after intravenous immunoglobulin amid host factors of ABO‐mismatched bone marrow transplantation, inflammation, and activated mononuclear phagocytes

“…A recently reported case of fatal passive hemolytic transfusion reaction (from a group O single donor apheresis PLT) occurred in an adult whose hematopoiesis had similarly converted from native group O to graft group A after transplantation, illustrating the vulnerability created by tissue‐restricted expression of A. We speculate that the gap in differential (or soluble) A antigen expression had imitated the particular vulnerability of D+ recipients with respect to the effects of large‐dose anti‐D infusions in the treatment of ITP, which at times may associate with severe intravascular hemolysis …”

Intramuscular anti‐D in chronic immune thrombocytopenia children with severe thrombocytopenia

“…Various doses and protocols of intramuscular anti‐D have been reported and overall these reports have demonstrated response in platelet increment in more than 50% of patients. Side‐effects, commonly found in patients receiving intravenous anti‐D, include fever, chill and decreased Hb level, but these have been less frequent with intramuscular anti‐D studies …”

“…[6][7][8] Various doses and protocols of intramuscular anti-D have been reported and overall these reports have demonstrated response in platelet increment in more than 50% of patients. Side-effects, commonly found in patients receiving intravenous anti-D, include fever, chill and decreased Hb level, 10 but these have been less frequent with intramuscular anti-D studies. [6][7][8] This study enrolled nine pediatric patients with platelet counts <20 × 10 9 /L while the other studies enrolled patients with higher platelet counts.…”

Influence of the American Society of Hematology Guidelines on the Management of Newly Diagnosed Childhood Immune Thrombocytopenia

“…Forty-seven percent were male. Additionally, 19.6% had bleeding symptoms, all with a platelet count less than 23 ×10 3 /μL and 80% with a platelet count less than 10 ×10 3 /μL. The most common bleeding symptoms were epistaxis (n = 25), wet purpura (n = 20), gastrointestinal bleeding (n = 5), hematuria (n = 4), and menstrual bleeding (n = 4).…”