Intravenous gamma globulin decreases platelet-associated IgG and improves transfusion responses in platelet refractory states
✍ Scribed by Dr. Zella R. Zeigler; Richard K. Shadduck; Craig S. Rosenfeld; Alan Winkelstein; Donna Przepiorka; Joseph E. Kiss; Rene J. Duquesnoy; Marilyn Marrari
- Publisher
- John Wiley and Sons
- Year
- 1991
- Tongue
- English
- Weight
- 675 KB
- Volume
- 38
- Category
- Article
- ISSN
- 0361-8609
No coin nor oath required. For personal study only.
✦ Synopsis
In an attempt to improve platelet transfusion responses, intravenous immunoglobulin (IV-IgG) was administered to 19 patients who were refractory to random and best available HLA-matched platelets. A response to IV-IgG was defined as two or more successive transfusions of HLA-matched products that provided recoveries greater than 30%.
Thirteen of 19 (68%) patients responded to therapy at a median time of 7 days after initiation of IV-IgG (range = 2-17). Baseline platelet associated IgG levels (PalgG) were elevated in both the responders (61.6 * 76.2) (mean t SD) and the non-responders (47.0 ? 46.3 fg/plt). Post-therapy, PalgG levels remained unchanged in the nonresponders but were decreased significantly (p = 0.05) to 11.1 ? 6.2 fg/plt in the responders. The latter levels were similar to those (11.6 ? 8.2 fg/plt) measured in a series of 36 transfusion responsive patients. This apparent decline in PalgG was not explained by differences in lymphocytotoxic antibodies (LCT-Ab) afler therapy. Moreover, a high degree of alloimmunization was associated with a poorer response to IgG. Only two of eight patients with LCT panel-reactive antibody (PRA) of >85% were responders. By contrast, improved transfusion outcomes were seen uniformly in patients with PRA ~8 5 % .
Improved recoveries were obtained using LCT-Ab compatible but not incompatible platelets. The median increment (% predicted) with compatible platelets before therapy was 6.0 2 9.9 (SD). Post-lgG, median recoveries were 37.0 ? 31.2 percent, P < 0.001.
These findings suggest that IV-IgG may alter destructive mechanisms that affect the survival of compatible platelets in refractory patients.