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Thromboembolic events as an emerging adverse effect during high-dose intravenous immunoglobulin therapy in elderly patients: a case report and discussion of the relevant literature

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An Erratum to this article was published on 04 March 2005

Abstract

A case of an 82-year-old man who suffered an acute ST-elevation myocardial infarction while receiving treatment with intravenous immunoglobulin (IVIg) for thrombocytopenia is discussed. A total of 29 other cases of thromboembolism related to IVIg therapy have been reported, and the incidence seems to be especially high in elderly patients with cerebrovascular risk factors and also in patients with paraproteinemias. Possible mechanisms to account for this complication may include some of the following: platelet activation, increased blood viscosity, contamination of IVIg with activated coagulation factors, induced arterial vasospasm, production of vasoconstrictive cytokines, and vasculitis. Ten patients out of the 29 reported patients died from this serious complication. In our patient, spontaneous reperfusion occurred without any treatment and he had an uneventful outcome.

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References

  1. Walsh PM (2003) Physicians’ desk reference, 57th edn. Thompson, Montvale

  2. Ratko TA, Burnett DA, Foulke GE et al (1995) Recommendations for off label use of intravenously administered immunoglobulin preparations. JAMA 273:1865–1870

    Article  CAS  PubMed  Google Scholar 

  3. Stangel M, Hartung HP, Marx P et al (1997) Review side effects of high-dose intravenous immunoglobulins. Clin Neuropharmacol 20(5):385–393

    CAS  PubMed  Google Scholar 

  4. Misbah SA, Chapel HM (1993) Adverse effects of intravenous immunoglobulin. Drug Saf 9(4):254–262

    CAS  PubMed  Google Scholar 

  5. Ryan ME, Webster ML, Statler JD (1996) Adverse effects of intravenous immunoglobulin therapy. Clin Pediatr (Phila) 35(1):23–31

    Google Scholar 

  6. Hayakawa F, Imada K, Towatari M et al (2002) Life-threatening human parvovirus B19 infection transmitted by intravenous immune globulin. Br J Haematol 118:1187–1189

    Article  PubMed  Google Scholar 

  7. Stangel M, Hartung HP, Marx P et al (1998) Intravenous immunoglobulin treatment of neurological autoimmune diseases. J Neurol Sci 153:203–214

    Article  CAS  PubMed  Google Scholar 

  8. Martin TD (1999) Safety and tolerability of intravenous immunoglobulins. Electroencephalogr Clin Neurophysiol Suppl 50:514–520

    CAS  PubMed  Google Scholar 

  9. Nydegger UE, Sturzenegger M (1999) Adverse effects of intravenous immunoglobulin therapy. Drug Saf 3:171–185

    Google Scholar 

  10. Kazatchkine MD, Kaveri SV (2001) Immunomodulation of autoimmune and inflammatory diseases with intravenous immune globulin. N Engl J Med 345:747–755

    Article  CAS  PubMed  Google Scholar 

  11. Turner B, Wills AJ (2000) Cerebral infarction complicating intravenous immunoglobulin therapy in a patient with Miller Fisher syndrome. J Neurol Neurosurg Psychiatry 68:790–791

    Google Scholar 

  12. Fruchter O, Blich M, Jacob G (2002) Fatal acute myocardial infarction during severe thrombocytopenia in a patient with idiopathic thrombocytopenic purpura. Am J Med Sci 323(5):279–280

    Article  PubMed  Google Scholar 

  13. Harkness KA, Goulding P (2000) Central retinal vein occlusion complicating treatment with intravenous immunoglobulin. Eye 14(Pt 4):662–663

    PubMed  Google Scholar 

  14. Haplea SS, Farrar JT, Gibson GA et al (1997) Thromboembolic events associated with intravenous immunoglobulin therapy (abstract). Neurology 48:A54

    Google Scholar 

  15. Steinberger B, Coleman TA (2001) Multiple complications of IVIg therapy in a patient with Guillain–Barré syndrome. Am J Hematol 67(1):59

    Article  CAS  Google Scholar 

  16. Strasser-Fuchs S, Fazekas F, Deisenhammer F et al (2000) The Austrian Immunoglobulin in MS (AIMS) study: final analysis. Mult Scler 6[Suppl 2]:S9–S13

    CAS  PubMed  Google Scholar 

  17. Poehlau D et al (2000) Treatment of chronic progressive multiple sclerosis with intravenous immunoglobulins—interim results on drug safety of an ongoing study. Mult Scler 6[Suppl 2]:S21–S23

    CAS  PubMed  Google Scholar 

  18. Leger JM, Chassande B, Musset L et al (2001) Intravenous immunoglobulin therapy in multifocal motor neuropathy—a double-blind, placebo-controlled study. Brain 124:145–153

    Article  CAS  PubMed  Google Scholar 

  19. Otsuki T, Funakawa T, Sugihara T et al (1997) Multiple cerebral infarctions in a patient with refractory idiopathic thrombocytopenic purpura. J Intern Med 241:249–252

    Article  CAS  PubMed  Google Scholar 

  20. Alliot C, Rapin JP, Besson M et al (2001) Pulmonary embolism after intravenous immunoglobulin. J R Soc Med 94:187–188

    CAS  PubMed  Google Scholar 

  21. Fuchi T, Kondo T, Sase K et al (1999) Primary percutaneous transluminal coronary angioplasty performed for acute myocardial infarction in a patient with idiopathic thrombocytopenic purpura. Jpn Circ J 63:133–136

    Article  CAS  PubMed  Google Scholar 

  22. Wolfe GI, Barohn RJ, Foster BM et al (2002) Randomized, controlled trial of intravenous immunoglobulin in mysthenia gravis. Muscle Nerve 26:549–552

    Article  CAS  PubMed  Google Scholar 

  23. Mendell JR, Barohn RJ, Freimer ML et al (2001) Randomized controlled trial of IVIg in untreated chronic inflammatory demyelinating polyradiculoneuropathy. Neurology 56:445–449

    CAS  PubMed  Google Scholar 

  24. Crouch ED, Watson LE (2002) Intravenous immunoglobulin-related acute coronary syndrome and coronary angiography in idiopathic thrombocytopenic purpura: a case report and literature review. Angiology 53:113–117

    PubMed  Google Scholar 

  25. Byrne NP, Henry JC, Herrmann DN et al (2002) Neuropathologic findings in a Guillain–Barré patient with strokes after IVIg therapy. Neurology 59:458–461

    Google Scholar 

  26. Jurlander J, Hartmann Geisler C, Hansen MM (1994) Treatment of hypogammaglobulinaemia in chronic lymphocytic leukaemia by low-dose intravenous gammaglobulin. Eur J Haematol 53:114–118

    CAS  PubMed  Google Scholar 

  27. Cooperative group for the study of immunoglobulin in chronic lymphocytic leukemia (1988) Intravenous immunoglobulin for the prevention of infection in chronic lymphocytic leukemia—a randomized, controlled clinical trial. N Engl J Med 319:902–907

    PubMed  Google Scholar 

  28. Sherer Y, Levy Y, Langevitz P et al (2001) Adverse effects of intravenous immunoglobulin therapy in 56 patients with autoimmune diseases. Pharmacology 62:133–137

    Google Scholar 

  29. Wolberg AS, Kon RH, Monroe DM et al (2000) Coagulation factor XI is a contaminant in intravenous immunoglobulin preparations. Am J Hematol 65:30–34

    Article  CAS  PubMed  Google Scholar 

  30. Koch CA, Archer TP, Kraut EH (1997) Myocardial ischemia in a patient with chronic refractory idiopathic thrombocytopenic purpura (letter). Arch Intern Med 157:2668

    Article  CAS  Google Scholar 

  31. Mathy I, Gille M, Van Raemdonck F et al (1998) Neurological complications of intravenous immunoglobulin (IVIg) therapy: an illustrative case of acute encephalopathy following IVIg therapy and a review of the literature. Acta Neurol Belg 98:347–351

    CAS  PubMed  Google Scholar 

  32. Woodruff RK, Grigg AP, Firkin FC, Smith IL (1986) Fatal thrombotic events during treatment of autoimmune thrombocytopenia with intravenous immunoglobulin in elderly patients (letter). Lancet 2:217–218

    Article  CAS  PubMed  Google Scholar 

  33. Silbert PL, Knezevic WV, Bridge DT (1992) Cerebral infarction complicating intravenous immunoglobulin therapy for polyneuritis cranialis. Neurology 42:257–258

    Google Scholar 

  34. Reinhart WH, Berchtold PE (1992) Effect of high-dose intravenous immunoglobulin therapy on blood rheology. Lancet 339:662–664

    Article  CAS  PubMed  Google Scholar 

  35. Ropper AH, Adelman L (1992) Early Guillain–Barré syndrome without inflammation. Arch Neurol 49:979–981

    CAS  PubMed  Google Scholar 

  36. Dalakas MC (1994) High-dose intravenous immunoglobulin and serum viscosity: risk of precipitating thromboembolic events. Neurology 44:223–226

    Google Scholar 

  37. Steg RE, Lefkowitz DM (1994) Cerebral infarction following intravenous immunoglobulin therapy for myasthenia gravis. Neurology 44:1180–1181

    Google Scholar 

  38. Brannagan TH III, Nagle KJ, Lange DJ, Rowland LP (1996) Complications of intravenous immune globulin treatment in neurologic disease. Neurology 47:674–677

    Google Scholar 

  39. Rosenbaum JT (1997) Myocardial infarction as a complication of immunoglobulin therapy (letter). Arthritis Rheum 40(9):1732–1733

    CAS  Google Scholar 

  40. Fisman DN, Smilovitch M (1997) Intravenous immunoglobulin, blood viscosity and myocardial infarction. Can J Cardiol 13(8):775–777

    CAS  PubMed  Google Scholar 

  41. Oh KT, Boldt HC, Danis RP (1997) Iatrogenic central retinal vein occlusion and hyperviscosity associated with high-dose intravenous immunoglobulin administration. Am J Ophthalmol 124(3):416–418

    CAS  PubMed  Google Scholar 

  42. Go RS, Call TG (2000) Deep venous thrombosis of the arm after intravenous immunoglobulin infusion: case report and literature review of intravenous immunoglobulin-related thrombotic complications. Mayo Clin Proc 75:83–85

    CAS  PubMed  Google Scholar 

  43. Paolini R, Fabris F, Cella G (2000) Acute myocardial infarction during treatment with intravenous immunoglobulin for idiopathic thrombocytopenic purpura (ITP) (letter). Am J Hematol 65(2):177–178

    Article  CAS  PubMed  Google Scholar 

  44. Elkayam O, Paran D, Milo R et al (2000) Acute myocardial infarction associated with high dose intravenous immunoglobulin infusion for autoimmune disorders: astudy of four cases. Ann Rheum Dis 59:77–80

    Article  CAS  PubMed  Google Scholar 

  45. Evangelou N, Littlewood T, Anslow P et al (2003) Transverse sinus thrombosis and IVIg treatment: a case report and discussion of risk-benefit assessment for immunoglobulin treatment. J Clin Pathol 56:308–309

    Article  CAS  PubMed  Google Scholar 

  46. Emerson GG, Herndon CN, Sreih AG (2002) Thrombotic complications after intravenous immunoglobulin therapy in two patients. Pharmacotherapy 22(12):1638–1641

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, St. Luke’s/Roosevelt Hospital Center, 1000 Tenth Avenue, New York, NY, 10019, USA

    David Hefer

  2. Division of Hematology/Oncology, Department of Internal Medicine, St. Luke’s/Roosevelt Hospital Center, Columbia University College of Physicians & Surgeons, 1000 Tenth Avenue, New York, NY, 10019, USA

    Mohammed Jaloudi

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  1. David Hefer
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  2. Mohammed Jaloudi
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Correspondence to David Hefer.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s00227-005-1024-6

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Hefer, D., Jaloudi, M. Thromboembolic events as an emerging adverse effect during high-dose intravenous immunoglobulin therapy in elderly patients: a case report and discussion of the relevant literature. Ann Hematol 83, 661–665 (2004). https://doi.org/10.1007/s00277-004-0895-2

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  • DOI: https://doi.org/10.1007/s00277-004-0895-2

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