Skip to main content

Advertisement

Log in

Treatment of septic thrombocytopenia with immune globulin

  • Original Articles
  • Published:
Journal of Clinical Immunology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Kreger BE, Craven DE, McCabe WR: Gram negative bacteremia IV. Reevaluation of clinical features and treatment of 612 patients. Am J Med 68:344–355, 1980

    Google Scholar 

  2. Riedler GF, Straub PW, Frick PG: Thrombocytopenia in septicemia. A clinical study for the evaluation of its incidence and diagnostic value. Helv Med Acta 36:23–38, 1971

    Google Scholar 

  3. Oppenheimer L, Hryniuk WM, Bishop AJ: Thrombocytopenia in severe bacterail infections. J Surg Res 20:211–214, 1976

    Google Scholar 

  4. Neame PB, Kelton JG, Walker IR, Stewart IO, Nossel HL, Hirsh J: Thrombocytopenia in septicemia: The role of disseminated intravascular coagulation. Blood 56:88–92, 1964

    Google Scholar 

  5. Hawiger J, Steckley S, Hammond D,et al.: Staphlococcal induced human platelet injury mediated by protein A and immunoglobulin G Fc fragment receptor. J Clin Invest 64:931–937, 1979

    Google Scholar 

  6. Ausprunk DH, Das J: Endotoxin induced changes in human platelet membranes: Morphologic evidence. Blood 51:487–495, 1978

    Google Scholar 

  7. Kelton JG, Neame PB, Gauldie J, Hirsh J: Elevated platelet associated IgG in the thrombocytopenia of septicemia. N Engl J Med 300:760–764, 1979

    Google Scholar 

  8. Tate DY, Carlton GT, Johnson D, Sorenson RL,et al.: Immune thrombocytopenia in severe neonatal infections. J Pediat 98:449–453, 1981

    Google Scholar 

  9. Fehr J, Hoffman V, Kappeler U: Transient reversal of thrombocytopenia in idiopathic thrombocytopenic purpura by high dose intravenous gamma globulin. N Engl J Med 306:1254–1258, 1982

    Google Scholar 

  10. Morfini M, Vannucchi AM, Grossi A,et al.: Direct evidence that high dose intravenous gammaglobulin blocks splenic and hepatic sequestration of51Cr-labeled platelets in ITP. Thromb Haemostas 54:554, 1985

    Google Scholar 

  11. Dammacco F, Iodice G, Campobasso N: Treatment of adult patients with idiopathic thrombocytopenic purpura with intravenous immunoglobulin: Effects on circulating T cell subsets and PWM-induced antibody synthesis in vitro. Br J Haematol 62:125–135, 1986

    Google Scholar 

  12. Wangel AG, Lorenzetti M, Pettersson T: Polyclonal B-cell activation after intravenous immunoglobulin therapy in idiopathic thrombocytopenic purpura—an anti-idiotype response? Eur J Hematol 39:209–213, 1986

    Google Scholar 

  13. Sultan Y, Katzatchkine MD, Maisonneuve P, Nydegger UE: Anti-idiotypic suppression of autoantibodies to Factor VIII (antihaemophilic factor) by high dose intravenous gamma globulin. Lancet 2:765–768, 1984

    Google Scholar 

  14. Berchtold P, Dale GL, Tani P, McMillan R: Inhibition of autoantibody binding to platelet glycoprotein IIB/IIIa by anti-idiotypic antibodies in intravenous gamma globulin. Blood 74:2414–2417, 1989

    Google Scholar 

  15. Ellaurie M, Burns ER, Bernstein LJ, Shah K, Rubinstein A: Thrombocytopenia and human immunodeficiency virus in children. Pediatrics 82:905–908, 1988

    Google Scholar 

  16. Wilson JJ, Neame PB, Kelton JG: Infection induced thrombocytopenia. Semin Thromb Hemostas 8:217–233, 1982

    Google Scholar 

  17. George JN: Platelet immunoglobulin G: Its significance for the evaluation of thrombocytopenia and for understanding the origin of alpha granule proteins. Blood 76:859–870, 1990

    Google Scholar 

  18. Kim KS: High dose intravenous immune globulin impairs antibacterial activity of antibiotics. J Allerg Clin Immunol 84:579–588, 1989

    Google Scholar 

  19. Weissman LE, Lorenzetti M: High intravenous doses of human immune globulin suppress neonatal group B streptococcal immunity in rats. J Pediat 115:445–450, 1989

    Google Scholar 

  20. Schreiber J, Basker C, Priehs C, Sieber G: Deleterious effect of immune globulin in the treatment of H. influenzae B infection in infant rats. Pediat Res 21:334a, 1987

    Google Scholar 

  21. Baumann MA, Menitove JE, Aster RH, Anderson T: Urgent treatment of idiopathic thrombocytopenic purpura with single-dose gamma globulin infusion followed by platelet transfusion. Ann Intern Med 104:808, 1986

    Google Scholar 

  22. Berchtold P, McMillan R: Therapy of chronic idiopathic thrombocytopenia in adults. Blood 74:2309–2317, 1989

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Burns, E.R., Lee, V. & Rubinstein, A. Treatment of septic thrombocytopenia with immune globulin. J Clin Immunol 11, 363–368 (1991). https://doi.org/10.1007/BF00918802

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00918802

Key words

Navigation