Intravenous immune globulin for patients alloimmunized to random donor platelet transfusion

Abstract

Immune globulin, prepared as a chemically and enzymatically unmodified solution in 10 percent maltose at pH 4.25, was administered intravenously, at a dose of 0.4 g per kg per day for five consecutive days, to seven alloimmunized patients who had acute nonlymphocytic leukemia. All patients had an approximately threefold rise in IgG level. Five patients showed no change in lymphocytotoxic antibody (LCTAb) activity and no response to random donor platelets that were administered after the immune globulin. The activity of LCTAb either disappeared or diminished after immune globulin infusion in two patients, and they had borderline acceptable corrected count increments 1 hour after transfusion of pooled random-donor platelet transfusions. Because of the diminished LCTAb activity, the improvements in response to pooled random-donor platelet transfusions cannot be ascribed to the administration of immune globulin. High-dose intravenous immune globulin has not been shown to be effective in reversing the effects of alloimmunization.

γ-Globulins prepared from sera of multiparous women bind anti-HLA antibodies and inhibit an established in vivo human alloimmune response

“…3 In contrast to the recognized efficacy of IVIg therapy in autoimmune disorders, there is controversy regarding its benefit in transfusion-induced HLA alloimmunization. [5][6][7][8] Although several investigators have demonstrated that commercial IVIg preparations can inhibit anti-HLA in vitro, [28][29][30][31][32][33][34][35] the inhibition has been incomplete and may be the result of absence of the necessary …”

“…[1][2][3][4] Although IVIg therapy has been shown to have a benefit in raising platelet counts in autoimmune platelet disorders, it appears to be not efficacious in patients with platelet-induced HLA alloimmunization. [5][6][7][8] The reasons for this are unclear but may relate to the nature of the immune response and the mechanisms of action of IVIg, that is, Fc receptor blockade/inhibition 4,9 or anti-idiotypic regulation. [10][11][12] One of the mechanisms by which the peripheral antibody repertoire is regulated is via the production of antibodies reactive with the variable regions of other antibodies, that is, antiidiotypes.…”

2 Platelet Concentrates

“…IgG) in combination with platelet transfusion is not more effective than platelet transfusion alone [27,39].…”

Therapeutic Plasma Exchange

“…In desperate circumstances, however, considerations of organ availability have sometimes dictated use of an ABO-incompatible liver after pretransplantation TPE of the recipient, often with a satisfactory outcome. [229][230][231] However, the results have been inconclusive and transfusion of compatible platelets is still the best option. [218][219][220] Both A 2 and non-A 2 organs have been successfully engrafted.…”