Anti-RhD immunoglobulin in the treatment of immune thrombocytopenia
Eric Cheung, Howard A LiebmanJane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, University of Southern California-Keck School of Medicine, Los Angeles, CA, USAAbstract: Immune thrombocytopenia (ITP) is an acquired bleeding autoimmune disorder characterized by a markedl...
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| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2009-01-01
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| Series: | Biologics: Targets & Therapy |
| Online Access: | http://www.dovepress.com/anti-rhd-immunoglobulin-in-the-treatment-of-immune-thrombocytopenia-a2765 |
| _version_ | 1819292596210499584 |
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| author | Eric Cheung Howard A Liebman |
| author_facet | Eric Cheung Howard A Liebman |
| author_sort | Eric Cheung |
| collection | DOAJ |
| description | Eric Cheung, Howard A LiebmanJane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, University of Southern California-Keck School of Medicine, Los Angeles, CA, USAAbstract: Immune thrombocytopenia (ITP) is an acquired bleeding autoimmune disorder characterized by a markedly decreased blood platelet count. The disorder is variable, frequently having an acute onset of limited duration in children and a more chronic course in adults. A number of therapeutic agents have demonstrated efficacy in increasing the platelet counts in both children and adults. Anti-RhD immunoglobulin (anti-D) is one such agent, and has been successfully used in the setting of both acute and chronic immune thrombocytopenia. In this report we review the use of anti-D in the management of ITP. While the FDA-approved dose of 50 mg/kg has documented efficacy in increasing platelet counts in approximately 80% of children and 70% of adults, a higher dose of 75 μg/kg has been shown to result in a more rapid increase in platelet count without a greater reduction in hemoglobin. Anti-D is generally ineffective in patients who have failed splenectomy. Anti-RhD therapy has been shown capable of delaying splenectomy in adult patients, but does not significantly increase the total number of patients in whom the procedure can be avoided. Anti-D therapy appears to inhibit macrophage phagocytosis by a combination of both FcR blockade and inflammatory cytokine inhibition of platelet phagocytosis within the spleen. Anti-RhD treatment is associated with mild to moderate infusion toxicities. Rare life-threatening toxicities such as hemoglobinuria, acute renal failure and disseminated intravascular coagulation have been reported. Recommendations have been proposed to reduce the risk of these complications. Anti-D immunoglobulin can be an effective option for rapidly increasing platelet counts in patients with symptomatic ITP.Keywords: immune thrombocytopenia, RhD immunoglobulin |
| first_indexed | 2024-12-24T03:57:03Z |
| format | Article |
| id | doaj.art-8c27a3481c224548b27794267cd319dd |
| institution | Directory Open Access Journal |
| issn | 1177-5475 1177-5491 |
| language | English |
| last_indexed | 2024-12-24T03:57:03Z |
| publishDate | 2009-01-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Biologics: Targets & Therapy |
| spelling | doaj.art-8c27a3481c224548b27794267cd319dd2022-12-21T17:16:25ZengDove Medical PressBiologics: Targets & Therapy1177-54751177-54912009-01-012009default5762Anti-RhD immunoglobulin in the treatment of immune thrombocytopeniaEric CheungHoward A LiebmanEric Cheung, Howard A LiebmanJane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, University of Southern California-Keck School of Medicine, Los Angeles, CA, USAAbstract: Immune thrombocytopenia (ITP) is an acquired bleeding autoimmune disorder characterized by a markedly decreased blood platelet count. The disorder is variable, frequently having an acute onset of limited duration in children and a more chronic course in adults. A number of therapeutic agents have demonstrated efficacy in increasing the platelet counts in both children and adults. Anti-RhD immunoglobulin (anti-D) is one such agent, and has been successfully used in the setting of both acute and chronic immune thrombocytopenia. In this report we review the use of anti-D in the management of ITP. While the FDA-approved dose of 50 mg/kg has documented efficacy in increasing platelet counts in approximately 80% of children and 70% of adults, a higher dose of 75 μg/kg has been shown to result in a more rapid increase in platelet count without a greater reduction in hemoglobin. Anti-D is generally ineffective in patients who have failed splenectomy. Anti-RhD therapy has been shown capable of delaying splenectomy in adult patients, but does not significantly increase the total number of patients in whom the procedure can be avoided. Anti-D therapy appears to inhibit macrophage phagocytosis by a combination of both FcR blockade and inflammatory cytokine inhibition of platelet phagocytosis within the spleen. Anti-RhD treatment is associated with mild to moderate infusion toxicities. Rare life-threatening toxicities such as hemoglobinuria, acute renal failure and disseminated intravascular coagulation have been reported. Recommendations have been proposed to reduce the risk of these complications. Anti-D immunoglobulin can be an effective option for rapidly increasing platelet counts in patients with symptomatic ITP.Keywords: immune thrombocytopenia, RhD immunoglobulinhttp://www.dovepress.com/anti-rhd-immunoglobulin-in-the-treatment-of-immune-thrombocytopenia-a2765 |
| spellingShingle | Eric Cheung Howard A Liebman Anti-RhD immunoglobulin in the treatment of immune thrombocytopenia Biologics: Targets & Therapy |
| title | Anti-RhD immunoglobulin in the treatment of immune thrombocytopenia |
| title_full | Anti-RhD immunoglobulin in the treatment of immune thrombocytopenia |
| title_fullStr | Anti-RhD immunoglobulin in the treatment of immune thrombocytopenia |
| title_full_unstemmed | Anti-RhD immunoglobulin in the treatment of immune thrombocytopenia |
| title_short | Anti-RhD immunoglobulin in the treatment of immune thrombocytopenia |
| title_sort | anti rhd immunoglobulin in the treatment of immune thrombocytopenia |
| url | http://www.dovepress.com/anti-rhd-immunoglobulin-in-the-treatment-of-immune-thrombocytopenia-a2765 |
| work_keys_str_mv | AT ericcheung antirhdimmunoglobulininthetreatmentofimmunethrombocytopenia AT howardaliebman antirhdimmunoglobulininthetreatmentofimmunethrombocytopenia |