IVIG-Associated Maternal Pancytopenia during Treatment for Neonatal Alloimmune Thrombocytopenia

Abstract

Background Treatment for neonatal alloimmune thrombocytopenia (NAIT) primarily involves maternal administration of intravenous immunoglobulin (IVIG) therapy and prednisone according to protocols based on risk stratification. While IVIG is generally well tolerated, hematologic side effects are a potential complication. Case We present the successful management of a rare complication of maternal pancytopenia following standard IVIG treatment. Diagnosis was made during routine obstetric exams. Management included reducing IVIG dosage and adding daily prednisone. Additionally, infusion Lots possibly associated with the event were identified and avoided. Interventions resulted in the resolution of pancytopenia and the birth of a healthy infant without thrombocytopenia. Conclusion Pancytopenia is a rare complication of IVIG treatment in women with pregnancies complicated by NAIT. Serial complete blood counts at the time of treatment would allow for early detection and timely management of the patient. Additionally, limiting the number of infusion Lots may decrease the chance of the described complications.

Epidemiology and management of fetal and neonatal alloimmune thrombocytopenia

“…The most important maternal side effects are headache and flulike symptoms. One case of maternal pancytopenia was reported, in this case full blood count was normalized spontaneously 6 weeks after pregnancy [65,66]. Possible long-term effects on the development the immune system of children are not well known.…”

Noninvasive Prenatal Testing in Immunohematology—Clinical, Technical and Ethical Considerations

“…In a subsequent pregnancy, the woman will be offered close clinical follow-up, and most centers will start treatment with high-dose intravenous IgG (IVIg). In this context, it is prudent to mention that (1) IVIg is used off label for this indication as the efficacy in this condition has never been tested in a placebo-controlled clinical trial; (2) there is no international consensus of whom to treat, when to start treatment and dose of IVIg [ 38 ]; (3) there are significant side effects associated with IVIg treatment [ 39 , 40 , 41 , 42 ]; (4) this treatment is incredibly expensive and may easily exceed USD 100,000 per treated woman; (5) there is a worldwide shortage of IVIg [ 43 ]; and (6) treatment of one HPA-1a-immunized women requires tremendous donor efforts: 4.5 man-months of plasmapheresis [ 38 ].…”

Non-invasive risk-assessment and bleeding prophylaxis with IVIG in pregnant women with a history of fetal and neonatal alloimmune thrombocytopenia: management to minimize adverse events

“…Administration of IVIG caused adverse events in pregnant women that were treated for FNAIT: severe hemolysis dependent on isoagglutinin content of IVIG preparation can occur [14,15]. Herrmann et al reported IVIG-related pancytopenia [16]. Blood group A mothers are more likely to develop anemia during IVIG treatment of FNAIT [17].…”