Effect of intravenous immunoglobulin administration on erythrocyte and leucocyte parameters

Cicha, A; Fischer, Michael B.; Wesinger, Antonia; Haas, Sheila; Bauer, Wolfgang; Wolf, Hermann M.; Sauerwein, Kai M. T.; Reininger, Bärbel; Petzelbauer, Peter; Pehamberger, Hubert; Handisurya, Alessandra

doi:10.1111/jdv.14671

Cited by 9 publications

(32 citation statements)

References 37 publications

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“…Additional mechanisms, such as apoptosis or other cell death pathways, may also be involved, and we cannot exclude an effect of the IVIG treatment, as reported previously in some studies. 23,27,28,30,31 Compared with children with acute infection, most of the individuals with postacute hyperinflammation received IVIG treatment before sampling, some combined with glucocorticosteroids. The immunosuppressive effects of glucocorticoids are identified at the cytokine/chemokine level.…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that, in some cases, IVIG treatment could impair DC function and decrease monocyte and DC proportions. 23,25,[27][28][29][30][31] In addition, some heterogeneity was observed in the proportions of non-classical monocytes in Acute-Inf (CoV-2 + ) cases and additional heterogeneity in the proportions of classical and intermediate monocytes in individuals with severe myocarditis (MIS-C_MYO (CoV-2 + )) (Figures 3A and 3B), but there was no correlation with clinical data, including treatments, age (Table S1), and cytokine/chemokine measurements (Figures 2 and S2). Additional modifications were detected in individuals with acute SARS-CoV-2 infection (Acute-Inf (CoV-2 + ) cases), consisting of a decrease in mucosal-associated invariant T cells (MAIT) and an excess of naive and central memory CD4 + T cells (Figures 3A, 3B, S3C, and S3D).…”

Section: Low Monocyte and Dendritic Cell Frequencies In Individuals With Postacute Hyperinflammatory Illnessmentioning

confidence: 99%

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A monocyte/dendritic cell molecular signature of SARS-CoV-2-related multisystem inflammatory syndrome in children with severe myocarditis

Cevins

Luka

Smith

et al. 2021

Med

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Background SARS-CoV-2 infection in children is generally milder than in adults, yet a proportion of cases result in hyperinflammatory conditions often including myocarditis. Methods To better understand these cases, we applied a multi-parametric approach to the study of blood cells of 56 children hospitalized with suspicion of SARS-CoV-2 infection. Plasma cytokine and chemokine levels and blood cellular composition were measured, alongside gene expression both at the bulk and single cell levels. Findings The most severe forms of multisystem inflammatory syndrome in children related to SARS-CoV-2 (MIS-C), that resulted in myocarditis, were characterized by elevated levels of pro-angiogenesis cytokines and several chemokines. Single-cell transcriptomic analyses identified a unique monocyte/dendritic cell gene signature that correlated with the occurrence of severe myocarditis, characterized by sustained NF-κB activity, TNF-α signaling, associated with decreased gene expression of NF-κB inhibitors. We also found a weak response to type-I and type-II interferons, hyperinflammation and response to oxidative stress related to increased HIF-1α and VEGF signaling. Conclusions These results provide potential for a better understanding of disease pathophysiology. Funding Agence National de la Recherche (Institut Hospitalo-Universitaire Imagine, grant ANR-10-IAHU-01, Recherche Hospitalo-Universitaire, grant ANR-18-RHUS-0010, Laboratoire d’Excellence ‘‘Milieu Intérieur”, grant ANR-10-LABX-69-01, ANR-flash Covid19 “AIROCovid” and “CoVarImm”), Institut National de la Santé et de la Recherche Médicale (INSERM) and the “URGENCE COVID-19” fundraising campaign of Institut Pasteur

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Section: Discussionmentioning

confidence: 99%

Section: Low Monocyte and Dendritic Cell Frequencies In Individuals With Postacute Hyperinflammatory Illnessmentioning

confidence: 99%

A monocyte/dendritic cell molecular signature of SARS-CoV-2-related multisystem inflammatory syndrome in children with severe myocarditis

Cevins

Luka

Smith

et al. 2021

Med

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“…Neutropenia following IVIG therapy has been observed in case reports and series of neurological, hematological, and pediatric patients [20][21][22][23][24][25][26][27][28][29]. To the best of our knowledge, data on IVIG-induced hematological side effects in dermatological cohorts are restricted to a recent case series by Cicha et al [30]. Guidelines regarding the use of IVIG in dermatology fail to give advice on IVIG-related neutropenia [9].…”

Section: Introductionmentioning

confidence: 99%

Neutropenia resulting from high‐dose intravenous immunoglobulin in dermatological patients

Stoevesandt

Heitmann

Goebeler

et al. 2020

J Deutsche Derma Gesell

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SummaryBackground and objectivesCurrent guidelines recommend high‐dose intravenous immunoglobulin (IVIG) as a rescue therapy to treat severe cutaneous autoimmune disorders. Data on IVIG‐induced hematological adverse events are limited in dermatological patients. We assessed the incidence and clinical implications of IVIG‐induced neutropenia.Patients and methodsPatients who received one or several cycles of IVIG between 2014 and 2019 were retrospectively evaluated. IVIG was given according to standardized infusion protocols. Daily differential blood counts were performed. Information on clinical baseline data, dermatological diagnosis, immunosuppressive pre‐treatment, and IVIG‐related adverse events was retrieved from patient files.ResultsSeventeen patients received 106 IVIG treatment cycles. Neutrophil counts below 1,500/μL were documented during 36 (34.0 %) cycles, and neutrophils fell below 1,000/μL in 14 (13.2 %) cases. The average drop of neutrophils from day one (pre‐dose) to days 2 and 3 of IVIG therapy was statistically significant (p = 0.006, and p = 0.002, respectively) despite correction for hemodilution, and so was a slight decrease of thrombocytes (p = 0.029, and p = 0.011, respectively). Four patients developed seven episodes of bacterial infections during or immediately after IVIG therapy.ConclusionsIVIG‐induced neutropenia is frequent in dermatological patients. A risk of secondary bacterial infections cannot be excluded.

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“…In Fallserien aus der Neurologie, Hämatologie und Pädiatrie wird außerdem über Neutropenien während und nach Gabe von IVIG berichtet [20][21][22][23][24][25][26][27][28][29]. Nach unserem Kenntnisstand beschränken sich Daten zu hämatologischen Nebenwirkungen der IVIG-Therapie bei dermatologischen Patienten auf eine 2018 durch Cicha et al publizierte Fallserie [30]. Das Risiko einer Neutropenie wird in aktuellen Leitlinien zum dermatologischen Einsatz von IVIG nicht thematisiert [9].…”

Section: Introductionunclassified

“…Nach unserem Kenntnisstand beschränken sich Daten zu hämatologischen Nebenwirkungen der IVIG‐Therapie bei dermatologischen Patienten auf eine 2018 durch Cicha et al. publizierte Fallserie [30]. Das Risiko einer Neutropenie wird in aktuellen Leitlinien zum dermatologischen Einsatz von IVIG nicht thematisiert [9].…”

Section: Introductionunclassified

Neutropenie als Nebenwirkung der Therapie mit hochdosierten intravenösen Immunglobulinen in der Dermatologie

Stoevesandt¹,

Heitmann²,

Goebeler³

et al. 2020

J Deutsche Derma Gesell

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Zusammenfassung Hintergrund und Ziele: Leitlinien empfehlen hochdosierte intravenöse Immunglobuline (IVIG) zur Behandlung therapierefraktärer kutaner Autoimmunerkrankungen. Für dermatologische Patienten liegen nur wenige Daten zu hämatologischen Nebenwirkungen dieser Therapie vor. In der vorliegenden Arbeit werden Inzidenz und klinische Folgen der IVIG‐induzierten Neutropenie untersucht. Patienten und Methodik: Alle Datensätze von Patienten unserer Klinik, die zwischen 2014 und 2019 mindestens einen Zyklus einer IVIG‐Therapie erhalten haben, wurden retrospektiv ausgewertet. Die Infusionen erfolgten anhand standardisierter Protokolle, die tägliche Kontrollen des Differenzialblutbildes beinhalteten. Informationen zu klinischen Basisdaten, dermatologischer Hauptdiagnose, immunsuppressiver Vortherapie und IVIG‐assoziierten Nebenwirkungen wurden den Patientenakten entnommen. Ergebnisse: Siebzehn Patienten erhielten 106 Behandlungen mit IVIG. Während 36 (34,0 %) Zyklen wurden Neutrophilenzahlen < 1500/μl dokumentiert, in 14 (13,2 %) Fällen sanken diese unter 1000/μl. Der durchschnittliche Abfall der Neutrophilen von Tag 1 (vor Therapiebeginn) zu den Tagen 2 und 3 war trotz Korrektur des volumenbedingten Verdünnungseffektes statisch signifikant (p = 0,006 beziehungsweise p = 0,002). Dieses galt auch für einen leichten Abfall der Thrombozyten (p = 0,029 von Tag 1 zu 2, p = 0,011 von Tag 1 zu 3). Vier Patienten entwickelten sieben Episoden bakterieller Infekte während oder unmittelbar nach IVIG‐Therapie. Schlussfolgerungen: Neutropenien während einer IVIG‐Therapie dermatologischer Patienten sind häufig. Ein dadurch erhöhtes Risiko bakterieller Infektionen kann nicht ausgeschlossen werden.

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Effect of intravenous immunoglobulin administration on erythrocyte and leucocyte parameters

Cited by 9 publications

References 37 publications

A monocyte/dendritic cell molecular signature of SARS-CoV-2-related multisystem inflammatory syndrome in children with severe myocarditis

A monocyte/dendritic cell molecular signature of SARS-CoV-2-related multisystem inflammatory syndrome in children with severe myocarditis

Neutropenia resulting from high‐dose intravenous immunoglobulin in dermatological patients

Neutropenie als Nebenwirkung der Therapie mit hochdosierten intravenösen Immunglobulinen in der Dermatologie

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