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Real-world experience of anti-D immunoglobulin in immune thrombocytopenia

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Abstract

In developing countries, anti-D has been used in immune thrombocytopenia (ITP) as a cheaper alternative to human immunoglobulin. We aim to analyze the response and safety profile of anti-D in patients with severe ITP. A retrospective study was conducted at a tertiary care hospital in Northern India. Patients received a single intravenous infusion of 75 μg/kg anti-D. In total, 36 patients (20 females) were included in this study. The median duration from ITP diagnosis to anti-D therapy was 235 days (range 1–1613 days). Four (11.1%) patients received anti-D as an upfront treatment. The patients’ platelet counts rose significantly by the end of day three and continued to be significantly high until day 30 of receiving anti-D (p ≤ 0.001). The overall response rate (ORR) by day seven was 88.89%. There was no effect of age, sex, duration of disease, prior therapy, and platelet count on the ORR. Patients were followed up for a median duration of 52 days (longest follow-up: 3080 days). Six (6/36, 16.67%) patients continued to be in remission till the last follow-up. The hemoglobin fall was statistically significant on day three and day seven (p < 0.001 and p = 0.001) and got normalized by day 30. We observed equally good ORR in mixed populations and different phases of ITP along with long-term sustained response. The study demonstrates a quick and high response rate along with good safety profile to anti-D in all forms of ITP.

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Authors and Affiliations

  1. Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral), Delhi, 110010, India

    Kundan Mishra, Suman Kumar, Rajiv Kumar, Rajan Kapoor, Sanjeevan Sharma, Jasjit Singh, Satyaranjan Das, Ajay Sharma & Velu Nair

  2. Depatment of Lab Sciences and Molecular Medicine, Army Hospital (Research & Referral), Delhi, India

    Kanwaljeet Singh & Tathagat Chatterjee

  3. Department of Internal Medicine, PGIMER, Chandigarh, India

    Aditya Jandial

  4. Department of Radiotherapy and Oncology, IGMC Shimla, Himachal Pradesh, India

    Rajeev Sandal

  5. Division of Hematology and Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, 84112, USA

    Kamal Kant Sahu

  6. Department of Pediatrics, Army Hospital (Research & Referral), Delhi, India

    Sanjeev Khera

  7. Department of Internal Medicine, INHS Asvini, Mumbai, India

    Rajiv Kumar

  8. Department of Internal Medicine, Command Hospital (Eastern Command), Kolkata, India

    Rajan Kapoor

  9. Department of Internal Medicine, Command Hospital (Central Command), Lucknow, India

    Sanjeevan Sharma

  10. Department of Internal Medicine, Command Hospital (Western Command), Chandimandir, India

    Jasjit Singh

  11. Department of Internal Medicine, Command Hospital (Southern Command), Pune, India

    Satyaranjan Das

  12. Department of Clinical Hematology and Stem Cell Transplant, Sir Ganga Ram Hospital, Delhi, India

    Ajay Sharma

  13. Apollo Comprehensive Blood & Cancer Center (CBCC) Cancer Care, Ahmedabad, India

    Velu Nair

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  1. Kundan Mishra
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Correspondence to Suman Kumar.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. No animals were involved in the study. The study has been sanctioned by the Institutional Ethical committee (AHRR IEC45/2020).

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Mishra, K., Kumar, S., Singh, K. et al. Real-world experience of anti-D immunoglobulin in immune thrombocytopenia. Ann Hematol 101, 1173–1179 (2022). https://doi.org/10.1007/s00277-022-04829-4

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