Efficacy of Intravenous Immunoglobulin in the Treatment of Thrombotic Thrombocytopaenic Purpura

Dervenoulas, John; Tsirigotis, Panagiotis; Bollas, G.; Koumarianou, Anna; Pappa, Vassiliki; Mantzios, Georgios; Xiros, Nikolaos I.; Economopoulos, T.; Papageorgiou, Efstathios; Παππά, Μαρία; Raptis, S.

doi:10.1159/000046567

Cited by 20 publications

(15 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Failure of plasma exchange to result in benefit should prompt a re‐evaluation for an alternative explanation for clinical manifestations. If none is found, subsequent treatments are largely based on anecdotal reports and include cytotoxic agents such as vincristine (34–36) or cyclophosphamide (37,38), immunomodulation with high‐dose γ‐globulin (39–41) or cyclosporin (42), or splenectomy (43–45).…”

Section: Treatmentmentioning

confidence: 99%

Post-operative thrombotic thrombocytopenic purpura: A review

Naqvi

Baumann

Chang

2004

International Journal of Clinical Practice

View full text Add to dashboard Cite

Post-operative thrombotic thrombocytopenic purpura (TTP) is a recently recognised life-threatening clinical syndrome with considerable similarity to classic TTP in presentation and response to early treatment with plasma exchange. To date, 29 cases of TTP associated with surgery have been reported. The majority of cases have complicated vascular surgeries, with a few cases seen following gastrointestinal or orthopaedic procedures. Characteristically, patients develop microangiopathic haemolytic anaemia and consumptive thrombocytopenia 5 to 9 days following surgery with variable presence of fever, impaired renal function and altered mental status. The pathogenesis of post-operative TTP is speculative but may involve the release of large amounts of high-molecular-weight von Willebrand factor (vWF) multimers due to endothelial damage resulting from surgery in the setting of marginal levels of vWF-cleaving enzyme. The myriad of common post-surgical complications that may present with clinical manifestations similar to TTP may result in confusion with the potential for delay in the initiation of life-saving plasma-exchange therapy. It is important that physicians be alert to the phenomenon of post-operative TTP so that prompt recognition and treatment will prevent serious morbidity or mortality.

show abstract

Section: Treatmentmentioning

confidence: 99%

Post-operative thrombotic thrombocytopenic purpura: A review

Naqvi

Baumann

Chang

2004

International Journal of Clinical Practice

View full text Add to dashboard Cite

show abstract

“…However, following an initial response to TPE, about one-third of TTP patients will relapse [1,3,5]. In addition to TPE, immune-based treatments have also been successful in TTP, including splenectomy, B-lymphocyte depletion by the anti-CD20 monoclonal antibody rituximab, and treatment with intravenous immunoglobulin (IVIG) [1,[5][6][7][8][9][10][11]. Although the clinical effects of IVIG as a treatment for TTP have been variable in previous reports, the effect of IVIG on ADAMTS13 activity and inhibitor levels is not known [1,3,[7][8][9][10]12].…”

Section: Introductionmentioning

confidence: 99%

Intravenous immunoglobulin as an adjunct to plasma exchange for the treatment of chronic thrombotic thrombocytopenic purpura

Moore

Arnold²,

Leber³

et al. 2007

Vox Sanguinis

View full text Add to dashboard Cite

Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disease. Therapeutic plasma exchange (TPE) is the most effective therapy; however, despite TPE, about one-third of TTP patients will relapse. A subset of patients with TTP has antibodies to ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) and may become resistant to conventional treatments. We describe a patient with TTP and high-titre anti-ADAMTS13 antibodies who developed a chronic, relapsing course of TTP despite frequent TPE. Once adjuvant treatment with intravenous immunoglobulin (IVIG) was added, remission was achieved. Even during remission, anti-ADAMTS13 antibodies remained elevated. We conclude that IVIG may sustain remission in some patients with chronic, relapsing TTP.

show abstract

“…Only a non‐significant trend to benefit was noted in the IVIG group. In a study of thrombotic thrombocytopenic purpura, IVIG 0.4 g/kg/day for 5 days (versus placebo) was added onto therapy with antiplatelet agents, corticosteroids and plasmapheresis, but did not confer benefit on the end‐points of time to relapse and remission rate [18].…”

Section: Discussionmentioning

confidence: 99%