Treatment of septic thrombocytopenia with immune globulin

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Thrombocytopenia frequently complicates systemic infection and results from multiple possible mechanisms. We and others have demonstrated that platelet-associated IgG (PAIgG) levels are elevated in the majority of patients with septic thrombocytopenia. Corticosteroids may be undesirable as a treatment for thrombocytopenia for patients with severe infection because of their potential for suppressing the immune response. We hypothesized that septic thrombocytopenia is, in most cases, an immune disorder analogous to idiopathic thrombocytopenic purpura (ITP) which might respond to intravenous gamma-globulin as a treatment for increasing the platelet count in this disorder. Intravenous immune globulin (IVIG), 400 mg/kg daily for 3 days, was administered in a randomized double-blind placebo-controlled trial. Twenty-nine patients who developed thrombocytopenia during a documented, septic episode were studied. Patients with disseminated intravascular coagulation (DIC), hypersplenism, or drugs known to cause thrombocytopenia were excluded. Elevated PAIgG levels were documented in 52% of evaluable patients. Mean platelet counts in the IVIG group rose from 43K at study entry to 178K (411% rise) by Day 9. In the placebo group platelets rose from 51K to 125K (261% rise;P = 0.02). Seventy-seven percent of the IVIG group had a minimum peak rise of 35K, vs 56% of the placebo group. Three patients in the placebo group had a serious bleeding episode, vs one in the IVIG group. The use of IVIG to treat septic thrombocytopenia not associated with DIC leads to a more rapid, more sustained, and greater increase in platelet count than placebo. Its use is recommended in the septic patient who is bleeding or is likely to need invasive or surgical procedures.

Original languageEnglish (US)
Pages (from-to)363-368
Number of pages6
JournalJournal of Clinical Immunology
Volume11
Issue number6
DOIs
StatePublished - Nov 1991

Fingerprint

Thrombocytopenia
Immunoglobulins
Intravenous Immunoglobulins
Placebos
Platelet Count
Blood Platelets
Disseminated Intravascular Coagulation
Therapeutics
Immunoglobulin G
Hypersplenism
Hemorrhage
Idiopathic Thrombocytopenic Purpura
gamma-Globulins
Immune System Diseases
Infection
Adrenal Cortex Hormones
Pharmaceutical Preparations

Keywords

  • immune globulin
  • platelets
  • sepsis
  • Thrombocytopenia

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Treatment of septic thrombocytopenia with immune globulin. / Burns, Edward R.; Lee, Verna; Rubinstein, Arye.

In: Journal of Clinical Immunology, Vol. 11, No. 6, 11.1991, p. 363-368.

Research output: Contribution to journalArticle

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