SAFETY, EFFICACY AND TOLERABILITY OF INTRAVENOUS ANTI-D IMMUNOGLOBULIN IN NEWLY DIAGNOSED IMMUNE THROMBOCYTOPENIA IN CHILDREN

, Nivedita; Praveen C  Sobti; Sandeep  Kaushal

doi:10.22270/ijmspr.v1i2.6

Authors

, Nivedita MD Pediatrics, Dayanand Medical College and Hospital, Ludhiana
Praveen C Sobti Professor, Department of Paediatrics, Dayanand Medical College and Hospital, Ludhiana (141001).
Sandeep Kaushal Professor and Head, Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana (141001)

DOI:

https://doi.org/10.22270/ijmspr.v1i2.6

Keywords:

Anti D, Children, Immune thrombocytopenia, Newly diagnosed

Abstract

Objectives: To evaluate the effect of single dose (75 µg/kg) Anti-D in children with newly diagnosed immune thrombocytopenia in terms of its safety, efficacy and tolerability. Methods: This was a prospective study conducted in Dayanand Medical College and Hospital-a tertiary care hospital over a period of 18 months. In this study, nineteen children with newly diagnosed immune thrombocytopenia (10 males, 9 females) were included. Mean age of the children was 4.7 ± 3.2 years. Anti-D was administered as a single intravenous injection in a dose of 75 µg/kg. Main outcome variables taken were Increase in platelet count, fall in hemoglobin, change in AST, ALT, urea, creatinine, sodium and potassium levels and appearance of any adverse symptom. Results: The response rate to Anti-D was 89.4% (n = 17). Mean increase in platelet count was 125.5 ± 86.2 x 109 /L at 48 h and 257.5 ± 176.4 x 109 /L at day seven. Response at 48 h was seen in 88.2% of the children. Females showed a better response than males (p = 0.05). Anti-D did not have any significant effect on renal or liver function tests and it caused a mean fall of 1.76 ± 1.06 g/dL in hemoglobin. Mild adverse effects developed in 52% children which resolved spontaneously within 12 h. Conclusion: Anti-D shows a good response (89.4%) in children with newly diagnosed ITP with an acceptable safety profile. Adverse effects like fever and chills are common (52%).

Author Biographies

, Nivedita, MD Pediatrics, Dayanand Medical College and Hospital, Ludhiana

MD Pediatrics, Dayanand Medical College and Hospital, Ludhiana

Praveen C Sobti, Professor, Department of Paediatrics, Dayanand Medical College and Hospital, Ludhiana (141001).

Professor, Department of Paediatrics, Dayanand Medical College and Hospital, Ludhiana (141001).

Sandeep Kaushal, Professor and Head, Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana (141001)

Professor and Head, Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana (141001)

References

Andrew M, Blanchette V, Adams M, Ali K, Barnard D, Chan KW et al. (1992), “A multicenter study of the treatment of childhood chronic idiopathic thrombocytopenic purpura with anti-D”, J Pediatr., Vol. 120, pp. 522-7.

Blanchette V, Imbach P, Andrew M, Adams M, McMillan J, Wang E et al. (1994), “Randomized trial of intravenous immunoglobulin G, intravenous anti-D, and oral prednisone in childhood acute immune thrombocytopenic purpura”, Lancet, Vol. 344, pp. 703-7.

Bussel J B, Graziano J N, Kimberly RP, Pahwa S, Aledort L M (1991), “Intravenous anti-D treatment of immune thrombocytopenic purpura: analysis of efficacy, toxicity and mechanism of effect”, Blood , Vol. 77, pp. 1884-93.

Bussel J B, Tarantino M D, Nalysnyk L, Fahrbach K, Sercus B, Genereux M et al. (2007), “Efficacy and safety of Intravenous rhesus human immune globulin (IVRhIG) and standard polyclonal intravenous immune globulins (IVIG) in the treatment of immune thrombocytopenic purpura: A systematic review”, U.S. Hematology Touch Briefings, pp. 28-34.

Freiberg A, Mauger D (1998), “Efficacy, safety, and dose response of intravenous anti-D immune globulin (WinRho SDF) for the treatment of idiopathic thrombocytopenic purpura in children”, Semin Hematol., Vol. 35, pp. 23-7.

George J, Woolf S, Raskob G, Wasser J, Aledort L, Ballem P, et al. (1996), “Idiopathic Thrombocytopenic Purpura: A Practice Guideline Developed by Explicit Methods for The American Society of Hematology”, Blood , Vol. 88, pp. 3-40.

Hong F, Ruiz R, Price H, Griffiths A, Malinoski F and Woloski M (1998), Safety profile of WinRho Anti D. Seminars in hematology, Vol. 35, pp. 9-13.

Krishnamurti L, Charan V D, Desai N, Pati H, Choudhry V P (1984), “Anti-D immunoglobulin in the treatment of idiopathic thrombocytopenic purpura”, Indian J Pediatr., Vol. 61, pp. 179-82.

Mohsen S, Alfy E, Galila M (2006), “Randomized trial of Anti-D immunoglobulin versus low dose intravenous immunoglobulin in the treatment of childhood chronic idiopathic thrombocytopenic purpura”, Acta Heamatol., Vol. 115, pp. 46-52.

Naithani R, Kumar R, Mahapatra M, Tyagi S, Mishra P (2009), “Efficacy and safety of Anti-D for immune thrombocytopenic purpura”, Indian Pediatrics, Vol. 14, pp. 1-3.

Panzer S, Grumayer E R, Hass O A, Niessner H, Graninger W, “Efficacy of rhesus antibodies (anti-Rho(D)) in autoimmune thrombocytopenia: Correlation with response to high dose IgG and the degree of haemolysis”, Blut., Vol. 52, pp. 117–21.

Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold D, et al. (2009), “Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group”, Blood , Vol. 113, pp. 2386-93.

Salama A, Mueller-Eckhardt C and Kiefel V (1983), “Effect of intravenous immunoglobulin in immune thrombocytopenia/competitive inhibition of reticuloendothelial system function by sequestration of autologous red blood cells?”, Lancet, 1983; Vol. II, pp. 193- 5.

Salama A, Kiefel V, Amberg R, Mueller Eckhart C (1984), “Treatment of autoimmune thrombocytopenic purpura with rhesus antibodies (anti- Rho(d))”, Blut., Vol. 49, pp. 29–35.

Scaradavou A, Woo B, Woloski B M R, Cuningham-Rundles S, Ettinger L J, Aledort L M, et al. (1997), “Intravenous Anti-D treatment of immune thrombocytopenic purpura: experience in 272 patients”, Blood , Vol. 89, pp. 2689-700.

Shahgholi E, Vosough P, Sotoudeh K, Arjomandi K, Ansari S, Salehi S et al. (2008), “Intravenous immune globulin versus intravenous anti-D immune globulin for the treatment of acute immune thrombocytopenic purpura”, Indian J Pediatr, Vol. 75, pp. 1231- 4.

Soker M, Yaramis A, Ece A, Haspolat K, Devecioglu C, “A randomized trial of anti-D and intravenous immunoglobulin treatment in childhood acute immune thrombocytopenic purpura”, Dicle journal of medical school, Vol. 28, pp. 83-92.

Tarantino M D, Madden R M, Fennewald D L, Patel C C, Bertolone S J (1999), “Treatment of childhood acute immune thrombocytopenic purpura with anti-D immune globulin or pooled immune globulin”, J Pediatr., Vol. 134, pp. 21-6.

Tarantino M D, Young G, Bertolone S J, Kaunyak K A, Shafer F E, Kulkarni R, et al. (2006), “Single dose of anti D immune globulin at 75 ug/kg is as effective as intravenous immune globulin at rapidly raising the platelet count in newly diagnosed immune thrombocytopenic purpura in children”, The journal of pediatrics, Vol. 148, pp. 489-94