Skip to main content

Advertisement

SpringerLink
Log in

Intravenous Immunoglobulin-Induced Bradycardia in a Patient with Idiopathic Thrombocytopenic Purpura

  • Medicine
  • Published:
SN Comprehensive Clinical Medicine Aims and scope Submit manuscript

Abstract

Intravenous immunoglobulin (IVIG) is a plasma-derived product and one of the most effective choices in the treatment of immune thrombocytopenic purpura. Various cardiovascular complications such as hypotension, bradycardia, supraventricular tachycardia, and even acute myocardial infarction (MI) have been reported following IVIG infusion so far. Most of these patients had pre-existing cardiac underlying risk factors. In this article, we report a 30-year-old woman with no history of cardiac disease who developed severe symptomatic bradycardia during IVIG infusion. Bradycardia was initially managed with atropine injections and administration of theophylline oral solution. Despite this adverse effect, IVIG infusion was resumed for two more days and the therapy courses were finished.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data Availability

The data that support the findings of this study are available from the corresponding author, (MM), upon reasonable request.

Code Availability

Not applicable

References

  1. Fernandez-Cruz E, Alecsandru D, Sanchez RS. Mechanisms of action of immune globulin. Clin Exp Immunol. 2009;157(Suppl 1):1–2.

    Article  Google Scholar 

  2. Hansen RJ, Balthasar JP. Mechanisms of IVIG action in immune thrombocytopenic purpura. Clin Lab. 2004;50(3-4):133–40.

    CAS  PubMed  Google Scholar 

  3. Perez EE, Orange JS, Bonilla F, Chinen J, Chinn IK, Dorsey M, et al. Update on the use of immunoglobulin in human disease: a review of evidence. J Allergy Clin Immunol. 2017;139(3S):S1–S46.

    Article  CAS  Google Scholar 

  4. Guo Y, Tian X, Wang X, Xiao Z. Adverse effects of immunoglobulin therapy. Front Immunol. 2018;9:1299.

    Article  Google Scholar 

  5. Raheja H, Kumar V, Hollander G, Shani J, Greenberg Y. Intravenous immunoglobulin-induced profound bradycardia in a patient with idiopathic thrombocytopenic purpura. Am J Ther. 2018;25(5):e572–e4.

    Article  Google Scholar 

  6. Douedi S, Alshami A, Ashforth G, Maludum O, Carson M. Severe symptomatic bradycardia after intravenous immunoglobulin infusion: a rare manifestation. J Cardiol and Cardiovasc Sciences. 2020;4(1):14–17.

  7. Savasan S, Tuzcu V, Warrier I, Karpawich P. Cardiac rhythm abnormalities during intravenous immunoglobulin G infusion for treatment of thrombocytopenia. J Pediatr Hematol Oncol. 1997;19(3):254–7.

    Article  CAS  Google Scholar 

  8. Tufekci S, Coban A, Bor M, Yasa B, Nisli K, Ince Z. Cardiac rhythm abnormalities during intravenous immunoglobulin G (IVIG) infusion in two newborn infants: coincidence or association? Clin Case Rep. 2015;3(9):731–4.

    Article  Google Scholar 

  9. Llanos OL, Pino MI, Paydak H, Meena N. Theophylline: an alternative for critically-ill patients with bradycardia and asystole triggered by vasovagal maneuvers. B56 CRITICAL CARE CASE REPORTS: ICU TOXICOLOGY. American Thoracic Society International Conference Abstracts: American Thoracic Society; 2017. p. A3797-A.

  10. Barnes PJ. Theophylline. Am J Respir Crit Care Med. 2013;188(8):901–6.

    Article  CAS  Google Scholar 

  11. Paparella N, Alboni P, editors. Theophylline for treatment of bradyarrhythmias: when is it indicated? In: Cardiac Arrhythmias 1999; 2000 2000//. Milano: Springer Milan.

  12. Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, et al. 2018 ACC/AHA/HRS Guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2019;140(8):e382–482.

    PubMed  Google Scholar 

  13. Manlhiot C, Tyrrell PN, Liang L, Atkinson AR, Lau W, Feldman BM. Safety of intravenous immunoglobulin in the treatment of juvenile dermatomyositis: adverse reactions are associated with immunoglobulin A content. Pediatrics. 2008;121(3):e626–30.

    Article  Google Scholar 

  14. Rachid R, Bonilla FA. The role of anti-IgA antibodies in causing adverse reactions to gamma globulin infusion in immunodeficient patients: a comprehensive review of the literature. J Allergy Clin Immunol. 2012;129(3):628–34.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We would like to thank Ms. Rose Naderi of Duke University Trinity College of Arts and Sciences for English proofreading the manuscript.

Author information

Authors and Affiliations

  1. Hematology-Oncology Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Mohsen Esfandbod

  2. Internal Medicine Department, Sina Hospital, Tehran University of Medical Sciences, Hassan Abad Square, Tehran, 1136746911, Iran

    Masoud Mortezazadeh

  3. Pharmacotherapy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

    Golbarg Alavian

Authors
  1. Mohsen Esfandbod
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masoud Mortezazadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Golbarg Alavian
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

G.A. and M.M. contributed to data collection, writing, drafting of the manuscript, and critical appraisal of the manuscript. M.E. contributed to scientific writing and final revision

Corresponding author

Correspondence to Masoud Mortezazadeh.

Ethics declarations

Ethics Approval

In this study, no additional costs and procedures were imposed on the patient. We reported the standard treatment process of the patient retrograde. We maintained the patient’s privacy, and her written consent was obtained.

Consent to Participate

The patient has consented to the participation of this case report.

Consent for Publication

The participant has consented to the publication of this case report.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Medicine

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Esfandbod, M., Mortezazadeh, M. & Alavian, G. Intravenous Immunoglobulin-Induced Bradycardia in a Patient with Idiopathic Thrombocytopenic Purpura. SN Compr. Clin. Med. 3, 1789–1792 (2021). https://doi.org/10.1007/s42399-021-00937-w

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s42399-021-00937-w

Keywords

Search

Navigation