Thrombotic Thrombocytopenic Purpura: Report of a Case with a Possible Response to High-Dose Intravenous Gamma Globulin

Staszewski, Harry; Colbourn, Donald; Donovan, Virginia; Ludman, Harold

doi:10.1159/000205377

Cited by 12 publications

(4 citation statements)

References 4 publications

(5 reference statements)

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“…Contrary to a small number of case studies [13, 14, 15, 16, 17]reporting a beneficial effect of high-dose ivIGg, two subsequent studies [22, 23], where 3 and 17 patients were included respectively, are in agreement with us that there is no benefit by the addition of ivIgG to standard modalities. This is the largest study in TTP patients where 29 patients received ivIgG in addition to standard treatment and were compared to 15 patients receiving standard treatment alone.…”

Section: Discussionsupporting

confidence: 65%

“…However, their efficacy has not been clearly shown yet. The rationale for the use of immunoglobulins was based on the following: (a) It had been previously shown that both homologous and autologous platelet aggregation by plasma of TTP patients can be inhibited by normal adult IgG in vitro [11, 12], and (b) There had been sporadic cases published in the literature reporting the efficacy of ivIgG in inducing remission in TTP patients who had previously failed on the standard treatment with plasma exchange [13, 14, 15, 16, 17]. …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy of Intravenous Immunoglobulin in the Treatment of Thrombotic Thrombocytopaenic Purpura

Dervenoulas¹,

Tsirigotis²,

Bollas³

et al. 2001

Acta Haematol

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Thrombotic thrombocytopaenic purpura (TTP) is characterised by platelet aggregation in the capillaries, thrombocytopaenia and microangiopathic haemolytic anaemia that result in organ ischaemia, mainly of the CNS and kidneys. Since the institution of plasma exchange therapy no further treatments have been proved to improve the survival and the relapse rate of TTP patients. In this retrospective study, we evaluated the efficacy of normal human immunoglobulin treatment in 44 patients suffering from TTP. Patients were divided into two groups that either did not receive (group A: 15 patients) or received (group B: 29 patients) 400 mg/kg of human normal immunoglobulin intravenously (ivIgG) for 5 days. All patients received treatment with corticosteroids, anti-platelet agents and plasma exchange. The results clearly showed that there was no statistically significant difference between the two groups in either remission rate or time to relapse following remission. In conclusion, this study did not prove any beneficial effect of ivIgG in the treatment of TTP patients.

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Section: Discussionsupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Efficacy of Intravenous Immunoglobulin in the Treatment of Thrombotic Thrombocytopaenic Purpura

Dervenoulas¹,

Tsirigotis²,

Bollas³

et al. 2001

Acta Haematol

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“…Other therapies reported in Jehovah's Witness (JW) patients with TTP, such as plasmapheresis using hydroxyethylstartch [8] or a plasma substitute, Gelofusine [9] were avoided due to the patients severe anemia. We elected to manage this patient's TTP with IVIG and steroids based on case reports describing successful management of TTP with IVIG [10].…”

Section: Introductionmentioning

confidence: 99%

Thrombotic thrombocytopenic purpura induced by trimethoprim‐sulfamethoxazole in a Jehovah's witness

et al. 2007

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We report a case of Thrombotic Thrombocytopenic Purpura occurring as an allergic response to trimethoprim-sulfamethoxazole therapy (Bactrim TM , Septra 1 ) in a Jehovah's Witness patient. The patient presented with fulminant microangiopathic hemolytic anemia and thrombocytopenia within 48 hr of initiating therapy with trimethoprim-sulfamethoxazole. Other symptoms of drug hypersensitivity included nausea, vomiting, urticarial rash, and leukopenia. Because of her religious faith, the patient was supported without plasma therapy with use of intravenous immunoglobulin, steroids, rituximab, and erythropoietin. Am. J. Hematol. 82:679-681, 2007. V V C 2007 Wiley-Liss, Inc.

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“…Historically, IVIG was tried for TTP before PE became the first-line treatment. There have been some successful reports of IVIG therapy for TTP, including PE-or plasmainfusion-refractory cases: two children and 12 adults [16][17][18][19][20]. In summary, ten of those 14 patients responded to IVIG and achieved complete remission.…”

Section: Discussionmentioning

confidence: 99%

Intravenous gamma globulin for thrombotic microangiopathy of unknown etiology

et al. 2007

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We encountered the case of a 4-year-old boy with thrombotic microangiopathy (TMA) of unknown etiology. Verotoxin-induced hemolytic uremic syndrome (HUS), Streptococcus-pneumoniae-related HUS, factor H deficiency, drug-induced thrombotic thrombocytopenic purpura (TTP), and ADAMTS13 (von Willebrand factor-cleaving protease; a disintegrin-like and metalloprotease with thrombospondin type 1 repeats)-related TTP were excluded. His condition was refractory to anticoagulants and plasma exchange, and his clinical course was catastrophic, with central nervous system symptoms and progressive renal failure. However, factual treatment of intravenous gamma globulin (IVIG) ended the hemolysis and resulted in a rise in platelet count. He fully recovered except for end-stage renal failure, but he underwent a successful renal transplant after peritoneal dialysis. He has not suffered a relapse of TMA or an allograft rejection for 4 years. IVIG might be an option for some patients with TMA of unknown etiology refractory to conventional treatment.

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Thrombotic Thrombocytopenic Purpura: Report of a Case with a Possible Response to High-Dose Intravenous Gamma Globulin

Cited by 12 publications

References 4 publications

Efficacy of Intravenous Immunoglobulin in the Treatment of Thrombotic Thrombocytopaenic Purpura

Efficacy of Intravenous Immunoglobulin in the Treatment of Thrombotic Thrombocytopaenic Purpura

Thrombotic thrombocytopenic purpura induced by trimethoprim‐sulfamethoxazole in a Jehovah's witness

Intravenous gamma globulin for thrombotic microangiopathy of unknown etiology

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