Summary
Therapy for post-transfusion purpura (PTP) is controversial. We have evaluated the effect of high-dose IgG (HDIgG) in 11 PTP cases investigated in our institution and summarized the clinical data of 8 additional cases reported in the literature. Two of these 19 cases had to be eliminated from the analysis (1 patient received a total dose of less than 30 g of IgG; 1 patient died 2 days after starting HDIgG therapy from congestive heart failure). Out of a total of 17 cases, 16 had good or excellent response reaching normal platelet values within few days; only one failure was observed. Five patients relapsed, but attained complete remission after a second course (dose) of IgG. Total doses per course ranged between 52 and 180 g of IgG. Five different IgG preparations were used and seemed similarly effective. No adverse reactions were observed. We conclude that HDIgG is the treatment of choice for PTP.
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References
Berney SI, Metcalfe P, Wathen NC, Waters AH (1985) Post-transfusion purpura responding to high dose intravenous IgG: further observations on pathogenesis. Br J Haematol 61: 627–632
Chapman JF, Murphy MF, Berney SI, Ord J, Metcalfe P, Amess JAL, Waters AH (1987) Post-transfusion purpura associated with anti-Baka and anti-PIA2 platelet antibodies and delayed haemolytic transfusion reaction. Vox Sang 52: 313–317
Chong BH, Cade J, Smith JA, Tatoulis J (1986) An unusual case of Post-transfusion purpura: Good transient response to high-dose immunoglobulin. Vox Sang 51: 182–184
Fehr J, Hofmann V, Kappeler U (1982) Transient reversal of thrombocytopenia in idiopathic thrombocytopenic purpura by high-dose intravenous gamma globulin. N Engl J Med 306: 1254–1258
Gerstner JB, Smith MJ, Davis KD, Cimo PL, Aster RH (1979) Posttransfusion purpura: Therapeutic failure of PIA1-negative platelet transfusion. Am J Hematol 6: 71–75
Glud TK, Rosthoj S, Krogh Jensen M, Laursen B, Grunnet N, Jersild C (1983) High-dose intravenous immunoglobulin for post-transfusion purpura. Scand J Haematol 31: 495–500
Hamblin TJ, Naorose Abidi SM, Nee PA, Copplestone A, Mufti GJ, Oscier DG (1985) Successful treatment of post-transfusion purpura with high-dose immunoglobulins after lack of response to plasma exchange. Vox Sang 49: 164–167
Kiefel V, Santoso S, Glöckner WM, Katzmann B, Mayr W, Mueller-Eckhardt C (1988) Post-transfusion purpura associated with an antibody against an allele of the Baka antigen. Vox Sang (in press)
Kiefel V, Santoso S, Katzmann B, Mueller-Eckhardt C (1988) A new platelet-specific alloantigen Bra. Report of four cases with neonatal alloimmune thrombocytopenia. Vox Sang 54: 101–106
Kiefel V, Santoso S, Weisheit M, Mueller-Eckhardt C (1987) Monoclonal antibody-specific immobilization of platelet antigens (MAIPA): A new tool for the identification of platelet-reactive antibodies. Blood 70: 1722–1726
Mueller-Eckhardt C (1986) Posttransfusion Purpura. Br J Haematol 64: 419–424
Mueller-Eckhardt C, Kiefel V, Mueller-Eckhardt G, Bambauer R, Baur J, Behringhoff B, Deuss U, Heinrich D, Klein HO, Lechner K, Maas D, Panzer S, Sprenger R, Stählin H, Vahrson H (1986) Posttransfusion purpura — A survey of 13 cases. Klin Wochenschr 64: 1198–1203
Mueller-Eckhardt C, Küenzlen E, Thilo-Körner D, Pralle H (1983) High-dose intravenous immunoglobulin for post-transfusion purpura. N Engl J Med 308: 287
Schneider W, Schnaidt M (1981) The platelet adhesion fluorescence test: a modification of the platelet suspension immunofluorescence test. Blut 43: 389–392
Shulman NR, Aster RH, Leitner A, Hiller MC (1960) A new syndrome of post-transfusion immunologic purpura. J Clin Invest 39: 1028–1031
Shulman NR, Jordan JV (1987) Platelet immunology. In: Colman RW, Hirsh J, Marder VJ, Salzman EW (eds) Hemostasis and thrombosis, 2nd Edn. J.B. Lippincott, Philadelphia, pp 452–529
Vogelsang G, Kickler TS, Bell WR (1986) Post-transfusion purpura: A report of five patients and a review of the pathogenesis and management. Am J Hematol 21: 259–267
Walker WS, Yap PL. Kilpatrick DC, Bolton FE, Crawford RJ, Sang CTM (1988) Post transfusion purpura following open heart surgery: Management by high dose intravenous immunoglobulin transfusion. Blut (in press)
Weisberg L, Linker CA (1984) Prednisone therapy of post-transfusion purpura. Ann Intern Med 100: 76–77
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Mueller-Eckhardt, C., Kiefel, V. High-dose IgG for post-transfusion purpura-revisited. Blut 57, 163–167 (1988). https://doi.org/10.1007/BF00319544
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DOI: https://doi.org/10.1007/BF00319544