Association of immune globulin intravenous and thromboembolic adverse events

Ovanesov, Mikhail V.; Menis, Mikhail; Scott, Dorothy E.; Forshee, Richard A.; Anderson, Steven A.; Bryan, Wilson W.; Golding, Basil

doi:10.1002/ajh.24644

Cited by 10 publications

(8 citation statements)

References 4 publications

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“…Additional immunosuppressive agents and apheresis with albumin replacement may not be necessary. It may be prudent to avoid IVIg because its efficacy is unknown and adverse reactions to IVIg may mimic the thrombotic, 12 neurologic, 13 and renal 14 manifestations of TTP.…”

Section: Resultsmentioning

confidence: 99%

Management of thrombotic thrombocytopenic purpura without plasma exchange: the Jehovah’s Witness experience

2017

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Section: Resultsmentioning

confidence: 99%

Management of thrombotic thrombocytopenic purpura without plasma exchange: the Jehovah’s Witness experience

2017

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“…An electrocardiogram demonstration right axis deviation, troponin-I was newly detectable at 0.06 ng/mL and Bnatriuretic peptide (BNP) increased to 1617 pg/mL. She Due to concern for inflammatory multi-system organ involvement similar to that seen in MIS-C, and risk of progression to more florid cardiac involvement, a riskbenefit discussion was held with the patient regarding treatment with intravenous immunoglobulin (IVIG), including potential risk of hypercoagulability [6]. She was treated with IVIG 2 g/kg split equally between hospital days 2 and 3 to reduce risk for thromboembolic and renal toxicities, along with aspirin 325 mg daily for 7 days, based on treatment courses suggested for pediatric patients with MIS-C or Kawasaki disease [7][8][9].…”

Section: Case Presentationmentioning

confidence: 99%

A young adult with COVID-19 and multisystem inflammatory syndrome in children (MIS-C)-like illness: a case report

et al. 2020

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Background A healthy 25-year-old woman developed COVID-19 disease with clinical characteristics resembling Multisystem Inflammatory Syndrome in Children (MIS-C), a rare form of COVID-19 described primarily in children under 21 years of age. Case presentation The patient presented with 1 week of weakness, dyspnea, and low-grade fevers, followed by mild cough, sore throat, vomiting, diarrhea, and lymph node swelling. She was otherwise healthy, with no prior medical history. Her hospital course was notable for profound acute kidney injury, leukocytosis, hypotension, and cardiac dysfunction requiring ICU admission and vasopressor support. MIS-C-like illness secondary to COVID-19 was suspected due to physical exam findings of conjunctivitis, mucositis, and shock. She improved following IVIG, aspirin, and supportive care, and was discharged on hospital day 5. Conclusion MIS-C-like illness should be considered in adults presenting with atypical clinical findings and concern for COVID-19. Further research is needed to support the role of IVIG and aspirin in this patient population.

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“…To date, evidence from controlled trials has been conflicting as to their success in severe COVID-19, and treatment is not given based on hyperinflammation [178,179]. Due to the current paucity of supporting evidence and risk of thromboembolic events associated with IVIG therapy, especially due to reports of hypercoagulability in severe COVID-19, IVIG, hyperimmune globulin, and convalescent plasma remain investigational [1,180].…”

Section: Intravenous Immunoglobulin (Ivig)mentioning

confidence: 99%

Coronavirus disease 2019: investigational therapies in the prevention and treatment of hyperinflammation

Amigues

Pearlman

Patel

et al. 2020

Expert Review of Clinical Immunology

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Introduction: The mortality of coronavirus disease 2019 (COVID-19) is frequently driven by an injurious immune response characterized by the development of acute respiratory distress syndrome (ARDS), endotheliitis, coagulopathy, and multi-organ failure. This spectrum of hyperinflammation in COVID-19 is commonly referred to as cytokine storm syndrome (CSS). Areas covered: Medline and Google Scholar were searched up until 15th of August 2020 for relevant literature. Evidence supports a role of dysregulated immune responses in the immunopathogenesis of severe COVID-19. CSS associated with SARS-CoV-2 shows similarities to the exuberant cytokine production in some patients with viral infection (e.g.SARS-CoV-1) and may be confused with other syndromes of hyperinflammation like the cytokine release syndrome (CRS) in CART cell therapy. Interleukin (IL)-6, IL-8, and tumor necrosis factor-alpha have emerged as predictors of COVID-19 severity and in-hospital mortality. Expert opinion: Despite similarities, COVID-19-CSS appears to be distinct from HLH, MAS, and CRS, and the application of HLH diagnostic scores and criteria to COVID-19 is not supported by emerging data. While immunosuppressive therapy with glucocorticoids has shown a mortality benefit, cytokine inhibitors may hold promise as 'rescue therapies' in severe COVID-19. Given the arguably limited benefit in advanced disease, strategies to prevent the development of COVID-19-CSS are needed.

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Association of immune globulin intravenous and thromboembolic adverse events

Cited by 10 publications

References 4 publications

Management of thrombotic thrombocytopenic purpura without plasma exchange: the Jehovah’s Witness experience

Management of thrombotic thrombocytopenic purpura without plasma exchange: the Jehovah’s Witness experience

A young adult with COVID-19 and multisystem inflammatory syndrome in children (MIS-C)-like illness: a case report

Coronavirus disease 2019: investigational therapies in the prevention and treatment of hyperinflammation

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