High-dose Intravenous Gammaglobulin Research Articles

Effective treatment with double filtration plasmapheresis (DEPP) and high dose intravenous gammaglobulin therapy in a pregnant systemic lupus erythematosus(SLE) patient.

症例は24才,女性. SLEの診断にて,昭和61年よりステロイド薬投与を行っていた.同年12月,妊娠2カ月を確認.本人の希望強く, SLEの経過も良好であったため,妊娠を継続した.妊娠36週, SLE増悪を認め入院.直ちにdouble filtration plasmapheresis (DFPP)および大量γ-globulin療法を行った.治療により症状改善を認め,妊娠38週めに健康な女児を無事娩出した.上記治療法は妊娠中のSLE悪に対し有効と考えられた.

Dramatic Effects of High-Dose Intravenous Gammaglobulin in Each Patient with Intractable Dermatomyositis and Polymyositis

Dramatic Effects of High-Dose Intravenous Gammaglobulin in Each Patient with Intractable Dermatomyositis and Polymyositis

9. C-REACTIVE PROTEIN IN KAWASAKI DISEASE

C- reactive protein (CRP) levels were investigated in 8 cases of Kawasaki disease (KD) all treated with high doses of intravenous gammaglobulin (400 mg/kg) for 3 days). Medium initial value of CRP was 190 mg/100 ml (range 129-284). The delay between the onset of the disease and treatment was 12.5 days (5-24). In all cases CRP normalized dramatically with a mean delay of 3.5 days (range 0-7 dys) after the end of treatment. This biologic parameter normalized before other inflammatory tests, such as erythrocyte sedimentation rate, platelet count, fibrlnogen and IgE. Both apyrexia occured and skin lesions evolution stopped. One patient with coronary artery involvement was treated after a delay of 24 days when cardiac lesions were already present. CRP value was normal 24 hours after the onset of treatment and coronary lesions stabilized. Monitoring of CRP appears to be an accurate index in clinical practice. Furthermore dramatic normalization of CRP should be considered of interest in immunoglobulin efficacy and in indirect approach of KD pathophysiology.

High‐dose intravenous gammaglobulin in Guillain‐Barré syndrome

Annals of NeurologyVolume 24, Issue 4 p. 588-588 Letter High-dose intravenous gammaglobulin in Guillain-Barré syndrome F. G. A. van der Meché Phd, MD, F. G. A. van der Meché Phd, MD Department of Neurology University Hospital Dijkzigt Rotterdam, The NetherlandsSearch for more papers by this authorR. P. Kleyweg MD, R. P. Kleyweg MD Department of Neurology University Hospital Dijkzigt Rotterdam, The NetherlandsSearch for more papers by this authorJ. Meulstee MD, J. Meulstee MD Department of Neurology University Hospital Dijkzigt Rotterdam, The NetherlandsSearch for more papers by this authorP. G. Oomes MD, P. G. Oomes MD Department of Neurology University Hospital Dijkzigt Rotterdam, The NetherlandsSearch for more papers by this author F. G. A. van der Meché Phd, MD, F. G. A. van der Meché Phd, MD Department of Neurology University Hospital Dijkzigt Rotterdam, The NetherlandsSearch for more papers by this authorR. P. Kleyweg MD, R. P. Kleyweg MD Department of Neurology University Hospital Dijkzigt Rotterdam, The NetherlandsSearch for more papers by this authorJ. Meulstee MD, J. Meulstee MD Department of Neurology University Hospital Dijkzigt Rotterdam, The NetherlandsSearch for more papers by this authorP. G. Oomes MD, P. G. Oomes MD Department of Neurology University Hospital Dijkzigt Rotterdam, The NetherlandsSearch for more papers by this author First published: October 1988 https://doi.org/10.1002/ana.410240425Citations: 6AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume24, Issue4October 1988Pages 588-588 RelatedInformation

Replacement therapy with high dose intravenous gamma-globulin improves chronic sinopulmonary disease in patients with hypogammaglobulinemia

In the last 30 years patients with antibody deficiency have benefited remarkably from regular replacement therapy with intramuscular immune serum globulin. In a proportion of patients this approach has not been successful in preventing sinopulmonary infections and progressive deterioration. The introduction of preparations of immune serum globulin suitable for intravenous administration provided the potential for examining the effects of achieving higher serum IgG levels. We have therefore evaluated and compared high vs low dose therapy in patients with hypogammaglobulinemia and sinopulmonary disease. To achieve minimum trough serum IgG levels of 500 mg/dl, we administered 0.6 g/kg every 4 weeks. High dose therapy proved efficacious in reducing symptoms, decreasing the frequency of major and minor infections and significantly improving pulmonary function. The improvement appeared to correlate with a marked reduction in the isolation of Mycoplasma, particularly Urea-plasma urealyticum, an important cause of infection in patients with hypogammaglobulinemia. High dose therapy with immune serum globulin suitable for intravenous administration appears to be the treatment of choice in patients with sinopulmonary disease.

Hypergammaglobulinemia can be associated with a positive direct antiglobulin test, a nonreactive eluate, and no evidence of hemolysis.

To determine the cause of a positive direct antiglobulin test (DAT), blood banks routinely perform serologic tests on eluates prepared from DAT-positive red cells. Negative eluates traditionally have been suspected to be associated with drug reactions. This report confirms that the most frequent cause of a positive DAT and a nonreactive eluate is hypergammaglobulinemia. The results of 74 patient samples with positive DATs were analyzed retrospectively. Eluates prepared from the red cells of 54 patients (72.9%) reacted; eluates from 20 patients (27.1%) did not react. This latter group had identical serologic and clinical findings, suggesting that they made up a homogeneous group. In particular, the patients had a positive DAT, a negative indirect antiglobulin test, and a negative eluate; an increased serum concentration of IgG; and no evidence of hemolysis. In a subsequent study, DATs were performed prospectively on red cells from 44 consecutive patients with elevated serum IgG levels. The serum IgG concentration was highest in the three patients whose red cells had a positive DAT. The DAT also became positive in two patients treated with high-dose intravenous gammaglobulin (IV IgG). These studies indicate that a negative eluate from red cells with a positive DAT, a common serologic finding, is often caused by hypergammaglobulinemia. The authors postulate that IgG binds nonspecifically to the red cells because of the hypergammaglobulinemia.

Immune Thrombocytopenia Treated with High-Dose Intravenous Gamma Globulin and Corticosteroids in Two Patients with Wiskott-Aldrich Syndrome

Wiskott-Aldrich syndrome (WAS) is a primary immunodeficiency disorder characterized by thrombocytopenia, atopic dermatitis, and susceptibility to recurrent infections. The thrombocytopenia, due to an intrinsic platelet defect, is only rarely complicated by immune thrombocytopenia (ITP). We report two patients with WAS in whom ITP complicated their thrombocytopenia. In addition, immune neutropenia accompanied the ITP in one patient. Whereas administration of high-dose intravenous gamma globulin (IGIV) alone did not ameliorate the ITP, corticosteroids did improve the ITP and immune neutropenia. High-dose IGIV appeared to be synergistic with corticosteroids and thus have a steroid-sparing effect.

Successful Treatment of Severe Aplastic Anemia in An Infant Assosiated with Cyclic Thrombocytopenia with High Dose Intravenous Gammaglobulin

Successful Treatment of Severe Aplastic Anemia in An Infant Assosiated with Cyclic Thrombocytopenia with High Dose Intravenous Gammaglobulin

A Patient with Graves' Disease who Developed Hypothyroidism Associated with Thyroid Stimulation Blocking Immunoglobulin during Anti-thyroid Drug Therapy.

A girl, 12 years of age, developed Graves' disease compounded with rheumatic fever and idiopathic thrombocytopenic purpura. Thrombocytopenia improved under short-term treatment with steroids and her mitral valvular insufficiency, due to the rheumatic fever, disappeared 4 years later. Initially, she had been treated with propylthiouracil (PTU) for 28 months. She suffered a relapse 9 months after stopping PTU and so she was given further PTU therapy. However, hypothyroidism developed 11 months after the initiation of therapy and continued, though further PTU treatment was discontinued. She now receives 1-thyroxine and maintains a euthyroid state. At the onset of the patient's hyperthyroidism, the TSH-binding inhibitor immunoglobulin (TBII) and the thyroid stimulating antibodies (TSAb) were found to be positive. During the remission period, only the thyroid stimulation blocking immunoglobulin (TSBI) was weakly positive. At relapse, only TBII was mildly positive. When hypothyroidism developed, both TBII and TSBI were positive, and TSAb was negative in all testings of her diluted IgGs. The patient's TBII and thyroid dysfunction were unaffected by high-dose intravenous gammaglobulin therapy or by treatment with prednisolone 0.5 mg/kg/day for 2 weeks. In conclusion, the emergence of TSBI during or after anti-thyroid drug therapy might possibly lead to hypothyroidism in patients with Graves' disease.

GAMMAGLOBULIN FOR CHRONIC SYSTEMIC JUVENILE ARTHRITIS.

Groothoff and van Leeuwen report the case of a six- year-old boy with severe juvenile arthritis that responded to high-dose intravenous gammaglobulin. Gammaglobulin was tried after several other drugs -- …

High-Dose Intravenous Gamma Globulin Improves Responses to Single-Donor Platelets in Patients Refractory to Platelet Transfusion

Abstract Ten patients, with bone marrow failure or malignant disorders, became refractory to platelet transfusions using random, as well as partial or fully HLA-matched, single-donor platelets. To determine its effect on platelet refractoriness, intravenous gamma globulin (IV IgG) was administered at 400 or 800 mg/kg/d for five days, and postinfusion platelet responses were monitored. Platelet transfusion responses following intravenous gamma globulin (IV IgG) were graded as follows: Excellent, 48-hour posttransfusion count greater than 50,000/microL; good, 48-hour count greater than 20,000 but less than 50,000/microL; Fair, increased increment, 48-hour count less than 20,000; and failed, no increased increment. Six of ten patients (60%) had improved responses to selected single-donor platelets (two were excellent, three were good, and one was fair). The time to achieve a platelet transfusion count greater than 25,000/microL ranged from one to nine days of IgG therapy. One individual had sustained benefit (greater than 1 year); the remaining responses persisted for 6 to 8 weeks. These results suggest that IV IgG may be useful in the management of platelet refractoriness, especially in patients receiving single-donor platelets.

High-dose intravenous gamma globulin improves responses to single-donor platelets in patients refractory to platelet transfusion

Ten patients, with bone marrow failure or malignant disorders, became refractory to platelet transfusions using random, as well as partial or fully HLA-matched, single-donor platelets. To determine its effect on platelet refractoriness, intravenous gamma globulin (IV IgG) was administered at 400 or 800 mg/kg/d for five days, and postinfusion platelet responses were monitored. Platelet transfusion responses following intravenous gamma globulin (IV IgG) were graded as follows: Excellent, 48-hour posttransfusion count greater than 50,000/microL; good, 48-hour count greater than 20,000 but less than 50,000/microL; Fair, increased increment, 48-hour count less than 20,000; and failed, no increased increment. Six of ten patients (60%) had improved responses to selected single-donor platelets (two were excellent, three were good, and one was fair). The time to achieve a platelet transfusion count greater than 25,000/microL ranged from one to nine days of IgG therapy. One individual had sustained benefit (greater than 1 year); the remaining responses persisted for 6 to 8 weeks. These results suggest that IV IgG may be useful in the management of platelet refractoriness, especially in patients receiving single-donor platelets.

Gulllain-barre syndrome: Treatment with high-dose intravenous gammaglobulin

Gulllain-barre syndrome: Treatment with high-dose intravenous gammaglobulin

High-dose intravenous gammaglobulin for chronic inflammatory demyelinating polyneuropathy.

We report our preliminary experience of high-dose intravenous gammaglobulin in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) selected for inefficacy or severe side effects of steroid and immunosuppressive treatment. Our treatment proved safe and effective, reversing the disability of CIDP, the improvement being temporally related to the commencement of intravenous high-dose gammaglobulin. The possible mechanisms of action are discussed.

High‐Dose Intravenous Gamma Globulin For Myasthenia Gravis: An Alternative to Plasma Exchange?

Annals of the New York Academy of SciencesVolume 505, Issue 1 p. 842-844 High-Dose Intravenous Gamma Globulin For Myasthenia Gravis: An Alternative to Plasma Exchange? Ph. GAJDOS, Ph. GAJDOS Hǒpital Raymond Poincaré 92380 Garches, FranceSearch for more papers by this authorH. D. OUTIN, H. D. OUTIN Hǒpital Raymond Poincaré 92380 Garches, FranceSearch for more papers by this authorE. MOREL, E. MOREL Hǒpital Raymond Poincaré 92380 Garches, FranceSearch for more papers by this authorJ. C. RAPHAEL, J. C. RAPHAEL Hǒpital Raymond Poincaré 92380 Garches, FranceSearch for more papers by this authorM. GOULON, M. GOULON Hǒpital Raymond Poincaré 92380 Garches, FranceSearch for more papers by this author Ph. GAJDOS, Ph. GAJDOS Hǒpital Raymond Poincaré 92380 Garches, FranceSearch for more papers by this authorH. D. OUTIN, H. D. OUTIN Hǒpital Raymond Poincaré 92380 Garches, FranceSearch for more papers by this authorE. MOREL, E. MOREL Hǒpital Raymond Poincaré 92380 Garches, FranceSearch for more papers by this authorJ. C. RAPHAEL, J. C. RAPHAEL Hǒpital Raymond Poincaré 92380 Garches, FranceSearch for more papers by this authorM. GOULON, M. GOULON Hǒpital Raymond Poincaré 92380 Garches, FranceSearch for more papers by this author First published: August 1987 https://doi.org/10.1111/j.1749-6632.1987.tb51387.xCitations: 40AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume505, Issue1Myasthenia Gravis: Biology and TreatmentAugust 1987Pages 842-844 RelatedInformation

HIGH DOSE INTRAVENOUS GAMMAGLOBULIN IN COOMBS POSITIVE HEMOLYTIC ANEMIA

Four patients with warm type autoimmune hemolytic anemia who failed to respond to steroid therapy received high dose intravenous gammaglobulin (0.2-0.4 g/kg daily) for five days. In one patient hemolysis occurred in association with non-Hodgkin's lymphoma and in the others the cause of the hemolysis was not established; two patients had prior splenectomy. A response to gammaglobulin therapy, demonstrable by a rise in or stabilisation of hemoglobin levels, a decrease in elevated serum bilirubin and lactate dehydrogenase levels, or prolongation of a shortened red cell (51Cr) survival, was observed in three patients. In two of these patients the effect of gammaglobulin therapy was temporary but allowed for splenectomy to proceed in one patient, without blood transfusion. The third patient continued to improve after cessation of gammaglobulin treatment. These findings suggest that high dose intravenous gammaglobulin may temporarily ameliorate hemolysis in some individuals with warm type immune hemolytic anemia, and may be a useful adjunct to steroids immediately before splenectomy.

Intravenous Treatment with Gammaglobulin in Adults with Immune Thrombocytopenic Purpura: Review of the Literature1

The results of high-dose intravenous gammaglobulin therapy (IVGG) of adults with immune thrombocytopenic purpura (ITP) were reviewed in 28 published reports which included 282 patients. Overall, 64% of the patients responded to IVGG with a peak platelet count greater than 100,000/mm3; 83% had peak platelet counts greater than 50,000/mm3. Unmodified immunoglobulin was superior to modified immunoglobulin; 70% of the patients treated with the former having platelet increases to greater than 100,000/mm3 compared to only 49% of those treated with the latter. More patients were refractory among those who had had ITP for at least 3 years. A higher peak platelet count immediately after IVGG administration was correlated with a longer duration of the platelet response. Patients above the age of 60 tended to have a weaker response to IVGG than did younger patients, and females tended to respond better than males. A pre-IVGG platelet count of less than 10,000/mm3 was not associated with a poor response to IVGG. While there is still no way to reliably predict response prior to therapy in an individual patient, the above information may help in the decision of whether or not treatment with IVGG is likely to be successful. It also suggests that inhibition of antiplatelet antibody production is an important mechanism of IVGG effect at least in some patients.

Binding and antibody blocking effects of intravenous IgG preparation on peripheral blood cells.

The mode of action of high dose intravenous gammaglobulin (IVGG) in idiopathic thrombocytopenic purpura (ITP) is controversial. This study used immunofluorescence techniques to investigate the possibility that IVGG binds to peripheral blood cells and that such binding blocks attachment of cell specific autoantibodies. IVGG bound to platelets, neutrophils, monocytes and lymphocytes. Erythrocytes appeared to bind only anti-A and anti-B present in the IVGG. Multimeric and monomeric fractions of IVGG also bound to these cells. However, F(ab')2 fragments of the IVGG reacted only weakly with platelets, neutrophils, monocytes and lymphocytes. Binding of IVGG to platelets and neutrophils did not prevent opsonization of these cells by monoclonal antibodies with specificities corresponding to those previously ascribed to platelet and neutrophil autoantibodies. This suggests that IVGG does not act by blocking attachment of autoantibodies to platelets in ITP.

Successful treatment of autoimmune hemolytic anemia in common variable immunodeficiency with high-dose intravenous gamma globulin

A patient with common variable immunodeficiency and autoimmune hemolytic anemia was given high-dose (450 mg/kg) intravenous gamma globulin (Sandoglobulin) for five days, followed by single doses of 100 to 200 mg/kg at four-week intervals or whenever the hemoglobin level and hematocrit fell or the reticulocyte count increased. This treatment was accompanied by a stabilization of hematopoietic parameters and reversal of Coombs' positivity, which have been sustained for 34 months. The use of high-dose gamma globulin for autoimmune hemolytic anemia can eliminate the need for other therapeutic modalities that may be detrimental to an immunocompromised host.

Management of Human Immunodeficiency Virus-Associated Thrombocytopenia with Intravenous Gamma Globulin

A 17-month-old boy in whom immune-mediated thrombocytopenia (ITP) was the presenting manifestation of infection with human immunodeficiency virus (HIV) is being successfully managed with intermittent high-dose intravenous gamma globulin (IVIG) allowing maintenance of hemostatic platelet counts while avoiding the immunosuppression associated with other therapeutic modalities used to treat ITP. He continues to demonstrate marked responsiveness to IVIG, and has been maintained on weekly or bimonthly infusions for 12 months. The serendipitous documentation of HIV infection prior to IVIG therapy for immune-mediated thrombocytopenia in this child documents the importance of HIV testing prior to IVIG therapy to prevent erroneous assignment of IVIG as the vehicle responsible for transmission of HIV infection. This case history also documents the importance of HIV testing in the diagnostic evaluation of immune-mediated thrombocytopenias.