Neutropenia after intravenous immunoglobulin therapy is associated with coronary artery lesions in children with Kawasaki disease: a case control study

Abstract

BackgroundTo evaluate differences in laboratory parameters, clinical presentation, and incidence of coronary artery lesions (CAL) between children with neutropenic and non-neutropenic Kawasaki disease (KD).MethodsAll consecutive KD patients that presented to the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University in Wenzhou, China between January 2005 and December 2015 were included in this study. Patients were divided into two groups (KD with neutropenia (NKD) and KD without neutropenia (NNKD)) based on whether or not they developed neutropenia during the course of treatment. We compared differences in clinical manifestations, laboratory parameters, and treatment protocols between groups. We also evaluated the relationship between neutropenia with immunoglobulin dosage and incidence of CAL.ResultsAn IVIG treatment regimen of 2 g/kg*1d was associated with a lower incidence of neutropenia compared to the 1 g/kg*2d protocol. The incidence of CAL was higher in KD patients with neutropenia than in those without. Subgroup analysis showed no difference in the incidence of CAL among the different age groups between KD patients with and without neutropenia.ConclusionsFollow up ultrasonic echocardiography should be performed in KD patients with neutropenia in order to allow for early detection of CAL and timely intervention.

Neutropenia Is Not Associated With the Outcomes in Patients With Kawasaki Disease

“…It was also pointed out that early neutropenia within the 10th day of disease onset played an important role in the prevention of CALs (16). In contrast, we found no significant differences in CALs in patients with and without neutropenia with baseline equilibrium after 1:4 propensity score matching, which was in line with Wang's study, although they set the time of CALs at a 3-month follow-up (17). The divergence was caused by different study designs, as we did not specifically focus on the time of neutropenia onset.…”

“…Otherwise, some other confounders might also play roles. Our results were not totally in line with a previous study, in which the authors showed patients with ANC larger than 6 had greater CALs rates (17). We attributed the divergence to the following reasons.…”

“…Although the risk factors of CALs were widely explored all over the world, which were mainly focused on the demographic and initial laboratory characteristics (21)(22)(23)(24), ANC was seldom studied (17). Interestingly, we found higher ANC was indicative of CALs.…”

Neutropenia resulting from high‐dose intravenous immunoglobulin in dermatological patients

“…Severe adverse events are considered to be rare, but may include anaphylaxis, aseptic meningitis, acute renal failure, thromboembolic events, and transfusion-related acute lung injury [15][16][17][18][19]. 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].…”

“…Severe adverse events are considered to be rare, but may include anaphylaxis, aseptic meningitis, acute renal failure, thromboembolic events, and transfusion-related acute lung injury [15][16][17][18][19]. Neutropenia following neurological, hematological, and pediatric patients [20][21][22][23][24][25][26][27][28][29].…”