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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Autores principales:	Eric Cheung, Howard A Liebman
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2009
Materias:	Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/8c27a3481c224548b27794267cd319dd
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spelling	oai:doaj.org-article:8c27a3481c224548b27794267cd319dd2021-12-02T02:49:53ZAnti-RhD immunoglobulin in the treatment of immune thrombocytopenia1177-54751177-5491https://doaj.org/article/8c27a3481c224548b27794267cd319dd2009-01-01T00:00:00Zhttp://www.dovepress.com/anti-rhd-immunoglobulin-in-the-treatment-of-immune-thrombocytopenia-a2765https://doaj.org/toc/1177-5475https://doaj.org/toc/1177-5491Eric 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 &mu;g/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 Eric CheungHoward A LiebmanDove Medical PressarticleMedicine (General)R5-920ENBiologics: Targets & Therapy, Vol 2009, Iss default, Pp 57-62 (2009)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine (General) R5-920
spellingShingle	Medicine (General) R5-920 Eric Cheung Howard A Liebman Anti-RhD immunoglobulin in the treatment of immune thrombocytopenia
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 &mu;g/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
format	article
author	Eric Cheung Howard A Liebman
author_facet	Eric Cheung Howard A Liebman
author_sort	Eric Cheung
title	Anti-RhD immunoglobulin in the treatment of immune thrombocytopenia
title_short	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_sort	anti-rhd immunoglobulin in the treatment of immune thrombocytopenia
publisher	Dove Medical Press
publishDate	2009
url	https://doaj.org/article/8c27a3481c224548b27794267cd319dd
work_keys_str_mv	AT ericcheung antirhdimmunoglobulininthetreatmentofimmunethrombocytopenia AT howardaliebman antirhdimmunoglobulininthetreatmentofimmunethrombocytopenia
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Anti-RhD immunoglobulin in the treatment of immune thrombocytopenia

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