Neutropenia resulting from high‐dose intravenous immunoglobulin in dermatological patients

Abstract

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.

Intravenous immunoglobulin for pembrolizumab‐induced bullous pemphigoid‐like eruption: A case report

“…Neutropenia related to IVIG is common. 3 It often occurs within 3 days after IVIG initiation and is mostly mild and transient, not requiring treatment. However, ICIs can also induce neutropenia, albeit rarely, and the median time to onset of the neutropenia is 60 days (range: 10-465 days) 4 and the median number of ICI cycles is three.…”