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Intravenous gamma globulin decreases platelet‐associated IgG and improves transfusion responses in platelet refractory states
Author(s) -
Zeigler Zella R.,
Shadduck Richard K.,
Rosenfeld Craig S.,
Winkelstein Alan,
Przepiorka Donna,
Kiss Joseph E.,
Duquesnoy Rene J.,
Marrari Marilyn
Publication year - 1991
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.2830380104
Subject(s) - platelet , medicine , refractory (planetary science) , antibody , gastroenterology , platelet transfusion , immunology , immunoglobulin g , gamma globulin , globulin , physics , astrobiology
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 (PaIgG) were elevated in both the responders (61.6 ± 76.2) (mean ± SD) and the non‐responders (47.0 ± 46.3 fg/plt). Post‐therapy, PaIgG 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 PaIgG was not explained by differences in lymphocytotoxic antibodies (LCT‐Ab) after 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 ≦ 85%. Improved recoveries were obtained using LCT‐Ab compatible but not incompatible platelets. The median increment (% predicted) with compatible platelets before therapy was 6.0 ± 9.9 (SD). Post‐IgG, 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.