Treatment of platelet alloimmunization with intravenous immunoglobulin in a child with aplastic anemia.
A 9-year-old girl with severe refractory aplastic anemia had become refractory to platelet transfusion due to platelet alloimmunization. As a result, a huge right parieto-temporo-occipital cerebral hematoma and a subarachnoid hemorrhage subsequently occurred. Intravenous immunoglobulin (IVIG) (Green Cross, Taiwan) at a dose of 0.4 g/kg/day for 5 days, followed by another 3 doses during the following 5 days, and combined with large-dose platelet transfusions effectively controlled the bleeding by elevating the platelet count to above 100 x 10(3)/mm3. The patient soon recovered with only a mild sequela. Two months later, because of multiple caries and a periodontal abscess, dental extraction needed to be performed. IVIG (0.4 g/kg/day x 6 days) enabled surgery to proceed by elevating the platelet count to above 55 x 10(3)/mm3, and no bleeding complications occurred during or after the procedure. The potential benefit of high-dose IVIG in modulating platelet alloimmunization is a result of increasing the survival of transfused platelets. Thus, this therapy is recommended when patients with platelet alloimmunization have critical bleeding episodes or undergo surgical procedures.
Chen
S H
SH
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China.
Liang
D C
DC
Lin
M
M
D000741:Anemia, Aplastic / Q000150:complications / Q000276:immunology*; D000917:Antibody Formation; D016824:Antigens, Human Platelet / Q000276:immunology*; D002543:Cerebral Hemorrhage / Q000150:complications; D002648:Child; D005260:Female; D006801:Humans; D007114:Immunization; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007518:Isoantibodies / Q000276:immunology*; D017713:Platelet Transfusion
D016824:Antigens, Human Platelet; D016756:Immunoglobulins, Intravenous; D007518:Isoantibodies