Intravenous immunoglobulin–induced acute thrombocytopenia

BACKGROUND Intravenous immunoglobulin (IVIG) has known efficacy in various hematologic conditions, including immune thrombocytopenic purpura. STUDY DESIGN AND METHODS We present the clinical course of a patient with splenic marginal zone lymphoma, who developed acute thrombocytopenia on three consec...

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Bibliographic Details
Published in:Transfusion (Philadelphia, Pa.) Pa.), 2018-02, Vol.58 (2), p.493-497
Main Authors: Gurevich‐Shapiro, Anna, Bonstein, Lilach, Spectre, Galia, Atweh, Nardeen, Gruenewal, Tsipora, Shapiro, Michael, Tadmor, Boaz, Raanani, Pia
Format: Article
Language:English
Subjects:
Agammaglobulinemia - blood
Agammaglobulinemia - drug therapy
Aged, 80 and over
Antigens
Binding
Cytometry
Female
Flow cytometry
Humans
Hypogammaglobulinemia
Immobilization
Immunofluorescence
Immunoglobulin G
Immunoglobulins
Immunoglobulins, Intravenous - administration & dosage
Immunoglobulins, Intravenous - adverse effects
Intravenous administration
Lymphoma
Lymphoma, B-Cell, Marginal Zone - blood
Lymphoma, B-Cell, Marginal Zone - drug therapy
Monoclonal antibodies
Platelets
Purpura
Spleen
Splenic Neoplasms - blood
Splenic Neoplasms - drug therapy
Thrombocytopenia
Thrombocytopenia - blood
Thrombocytopenia - chemically induced
Thrombocytopenic purpura
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Summary:BACKGROUND Intravenous immunoglobulin (IVIG) has known efficacy in various hematologic conditions, including immune thrombocytopenic purpura. STUDY DESIGN AND METHODS We present the clinical course of a patient with splenic marginal zone lymphoma, who developed acute thrombocytopenia on three consecutive episodes, with nadir counts of 27 × 109, 50 × 109, and 9 × 109/L, upon administration of Intratect IVIG for hypogammaglobulinemia. An immunofluorescence test applying flow cytometry and monoclonal antibody immobilization of platelet antigens (MAIPA) assay were used to evaluate the reaction between IgG present in the IVIG preparations and the patient's or healthy donors' platelets (PLTs). RESULTS A strong direct binding reaction was observed between the patient's PLTs and Intratect IgG using both methods. A similar reaction failed to materialize with controls. Binding was not antigen specific according to MAIPA. CONCLUSIONS This is the first reported case of thrombocytopenia as a possible adverse effect of IVIG.
ISSN:0041-1132
1537-2995
DOI:10.1111/trf.14419