Immunoglobulin Infusion Research Articles

S40. Acute and subacute motor neuropathy in type II diabetic patients

Introduction Diabetic neuropathy is the most common complication of diabetes mellitus (DM), affecting as many as 50% of patients with type 1 and type 2 DM. There are four main types of diabetic neuropathy; Peripheral neuropathy, autonomic neuropathy, radiculo-plexus neuropathy (diabetic-amyotrophy) and mononeuropathy. The aim of the study was to describe the clinical presentation, electrophysiological investigations and in the future the immunological profile of such patients. Methods Seven type II diabetic patients were selected for the study. Ethical approval and patients’ informed consent have been obtained. They are all presented with acute and subacute onset of predominantly lower limb distal muscle weakness, on occasion proximal. The onset of this weakness was not preceded by upper respiratory tract infection, diarrhea or febrile illness. Results On examination there was symmetrical weakness of the distal foot flexors and extensors (power ranges 0–3), lower limb reflexes varies from diminished to absent. Tone was normal in the majority and flaccid in some of the patients. All modalities of sensation are intact except for disturbance of light touch in two patients. All patients were investigated for other causes of neuropathies. Neurophysiological investigations revealed signs of predominant demyelination with axonal degeneration. Patients showed very good response to immunoglobulin infusion (i.e. recovery of weakness after one to three months). Immunological studies are undergoing. Conclusion This was a preliminary report of a very uncommon presentation of acute motor neuropathy in diabetic patients. The cause possibly might be immune-mediated nerve damage but this has to be confirmed when we recruit more patients with detailed immune-profile studies.

Long-term Results of an IgM-enriched Human Immunoglobulin-based Therapy for Early Donor Specific Antibodies After Lung Transplantation

The development of anti-HLA donor specific antibodies early after lung transplantation (eDSA) has been associated with a poor graft survival. Therefore, at our institution, we have pre-emptively treated patients with eDSA with successive infusions of IgM-enriched human intravenous immunoglobulins (IVIG, first infusion: 2gr/kg, then 0.5gr/kg once every 4 weeks for a maximum of 6 months), usually combined with a single dose of anti-CD20 antibody (Rituximab) since 2013. In some cases, therapeutic plasmapheresis (tPE) or immunoabsorption were added before the first IVIG dose. Aims of this study were to present the long-term results of the IVIG-based therapy and its impact on graft survival.

Guillain-Barre syndrome associated with hemorrhagic fever with renal syndrome in China: a case report

BackgroundWe describe a case of Guillain-Barre syndrome (GBS) associated with hemorrhagic fever with renal syndrome. To our knowledge, only five cases of GBS associated with Hantavirus infection have been reported so far.Case presentationsA 62-year-old man presented intermittent fever, chill and oliguria. According to remarkable leukocytosis, atypical lymphocytes, thrombocytopenia and former dwelling in hemorrhagic fever-endemic area, he was suspected as hemorrhagic fever with renal syndromeand certified with positive Hantavirus IgG. Later, the patient had symmetrical flaccid paralysis of all extremities. Electromyography showed peripheral nerve injury (mainly in axon). The patient was diagnosed as having acute motor sensory axonal neuropathy (AMSAN). After immunoglobulin infusion, patient showed progressive recovery and was transferred 3 weeks after his first admission to a rehabilitation center.ConclusionsOur case was the 6th reported case of GBS associated with hemorrhagic fever with renal syndrome. Moreover, we for the first time classified the subtype of GBS (AMSAN) based on the electrophysiology characteristics. GBS should be suspected in patients who are already diagnosed as hemorrhagic fever with renal syndrome when delayed symmetrical limb paralysis occurs. Until recent now, GBS was only reported in hemorrhagic fever patients in Europe and Asia, which termed as hemorrhagic fever with renal syndrome.

Outcomes of Prolonged Treatment With Intravenous Immunoglobulin Infusions for Acute Antibody-mediated Rejection in Kidney Transplant Recipients

BackgroundTreatment of antibody-mediated rejection (AMR) is one of the main problems after kidney transplantation (KTx). The results of intensive AMR treatment with plasmapheresis (PF) and repeated infusions of intravenous immunoglobulin (IVIg) are presented. MethodsDiagnosis of AMR was based on graft biopsy and the presence of donor-specific antibodies (DSAs). AMR therapy consisted of 5 PF and IVIg infusions given after the last PF. Subsequent IVIg doses were given every 4 weeks for 6 months. Graft biopsy and DSA assessment were repeated at the end of the treatment (ET). ResultsFour women and 10 men were included in our study; mean time from KTx to AMR was 79 (range, 3–193) months. During the treatment, 4 patients had graft failure. Graft function at baseline was significantly worse (P = .02) in this group compared with patients who completed the therapy. At baseline, mean flourescence intensity (MFI) was 6574 (range, 852–15,917) in the whole group, 7088 (range, 1054–15,917) in patients who completed treatment, and 4828 (range, 852–11,797) in patients who restarted hemodialysis. At ET, DSA MFI decreased in 8 of 10 patients (80%) who completed the therapy. The MFI decrease was 3946 (range, 959–11,203). Control graft biopsies revealed decreased intensity of C4d deposits in peritubular capillaries in 7 patients (78%) and decreased peritubular capillaritis in 2 patients (22%). ConclusionIntensive, prolonged AMR therapy with PF and IVIg resulted in a decrease in DSA titer and intensity of C4d deposits, but was not associated with reduction of microcirculation inflammation. Treatment was ineffective in patients with baseline advanced graft insufficiency.

In-depth interviews of patients with primary immunodeficiency who have experienced pump and rapid push subcutaneous infusions of immunoglobulins reveal new insights on their preference and expectations.

PurposePatients with primary immunodeficiency (PID) often receive immunoglobulin replacement therapy (IgRT). Physicians and patients have the choice between various methods of administration. For subcutaneous immunoglobulin infusions, patients may use an automated pump (P) or push the plunger of a syringe (rapid push [RP]). P infusions are performed once a week and last around 1 hour. RP decreases the duration of administration, but requires more frequent infusions.Patients and methodsEight out of 30 patients (coming from a single center) who had participated in the cross-over, randomized, open-label trial comparing P and RP participated in a focus group or underwent in-depth interviews. Patients had a long history of home-based subcutaneous immunoglobulin using P. The trial suggested that RP had slightly greater interference on daily life than P, but similar efficacy and better cost-effectiveness. When asked about the delivery method they had preferred, around one-third of patients pointed out RP rather than P. In-depth interviews may reveal unforeseen reasons for patients’ preferences.ResultsInterviews underlined the complexity of the relationship that the patients maintain with their disease and IgRT. Even if they recognized the genetic nature of the disease and claimed PID was a part of them, patients tried not to be overwhelmed by the disease. IgRT by P was well integrated in patients’ routine. By contrast, RP too frequently reminded the patients of their disease. In addition, some patients pointed out the difficulty of pushing the plunger due to the viscosity of the product. Coming back too frequently, RP was not perceived as time saving over a week. Long-lasting use of P could partly explain patients’ reasonable reluctance to change to RP.ConclusionIn-depth interviews of PID patients highlighted unforeseen reasons for patients’ preference that the physician needs to explore during the shared medical decision-making process.

Young Investigator: Common Variable Immunodeficiency Masquerading as Ulcerative Colitis

V.R. is a 24 year old, African American female, with a history of Lupus, recurrent UTI's, sinus infections, ear infections, pneumonia and a family history of Crohn's disease, who was originally referred to gastroenterology clinic for microcytic anemia. Over the two months prior to her initial visit, she was having multiple episodes of bilious emesis daily. Additionally, she was experiencing diffuse abdominal cramping and was having 3-4 loose BM's per day with occasional bright red blood coating her stool. She reported that she had been known to have anemia for many years but without a definitive explanation. She did endorse heavy menses which had not previously been evaluated. Repeat blood work noted iron deficiency anemia and there were no findings consistent with sickle cell. As a result of her anemia, she was scheduled for an EGD and colonoscopy. Her EGD was notable for monilial esophagitis as well as erythematous gastropathy and gastritis with biopsies reported as atypical lymphoid infiltrates. Her colonoscopy findings were notable for prominent lymphoid nodules in the ileum which were biopsied and found to be atypical lymphoid infiltrates. She had an inflamed appendiceal orifice consistent with a cecal patch which was biopsied and returned as atypical lymphoid infiltrates. Additionally, she had mild to moderate patchy proctosigmoiditis with biopsies again returning as atypical lymphoid infiltrates. The biopsies were reviewed by an expert pathologist who noted a paucity of plasma cells, confirmed with negative CD 138 immunostaining. Furthermore, staining for a malignant process such as lymphoma was found to be unlikely. Given the constellation of findings, immunoglobulin electrophoresis to check for Common Variable Immunodeficiency (CVID) was done as was flow cytometry to rule out lymphoma. Clonality was not established on flow cytometry and serum immunoglobulin electrophoresis was consistent with CVID with her IgG being low at 72, her IgA low at less than 7 and her IgM low at 29. She was referred to an immunologist who started her on immunoglobulin infusions. She has done well for nearly one year. CVID is defined as reduced concentrations of IgG along with low levels of IgA and/or IgM, a poor or absent response to immunizations, and not having another diagnosis of an immunodeficiency state. The majority of patients are diagnosed between ages 20 and 45. In a nearly forty year study looking at nearly 500 patients with CVID, it was found that 15% of them had gastrointestinal inflammatory disease. Diarrhea is the most common symptom in patients who have gastrointestinal disease and the most common presentation is one that resembles IBD, either ulcerative colitis or Crohn's disease. One theory regarding the IBD like inflammation in CVID patients may be related to abnormal cytokine production through a T-cell related pathway, however, given the variability of the presentation, there are likely multiple mechanisms involved. This case is significant for the practicing gastroenterologist. The patient's endoscopic presentation, clinical symptoms and lab findings were consistent with a diagnosis of ulcerative colitis. One must keep a broad differential in mind as it impacts treatment and surveillance.

Increase in T helper type 17 cells in children with Kawasaki disease is NR4A2 dependent

The aim of this study was to evaluate the relationship between T helper type 17 (Th17) cells and Kawasaki disease (KD). Flow cytometry results showed that the number of Th17 cells in the peripheral blood mononuclear cells (PBMCs) of KD patients was significantly elevated. Enzyme-linked immunosorbent assay (ELISA) results showed that the serum concentrations of two Th17 cytokines, interleukin (IL)-17 and IL-6, were significantly increased in KD patients. In addition, real-time quantitative polymerase chain reaction (PCR) results showed that the messenger RNA (mRNA) expression of two molecules related to Th17 cell differentiation, retinoic acid–related orphan receptor C (RORC) and NR4A2, was upregulated in the CD4+ T cells of KD patients. Intravenous immunoglobulin (IVIG) infusion significantly reduced the proportion of Th17 cells, decreased serum concentrations of IL-7 and IL-6, and lowered the mRNA levels of RORC and NR4A2 in IVIG treatment–sensitive KD patients. Finally, the results of a Pearson’s correlation analysis illustrated that IL-17 mRNA levels in CD4+ T cells of KD patients were positively correlated with NR4A2 but not RORC mRNA expression. Our results demonstrate that Th17 cells play an important role in KD development and IVIG treatment and that Th17 cells and IL-17 may be used as markers for the occurrence of KD or as treatment targets for KD therapies. In addition, our results suggest that the underlying mechanism of IL-17 production in KD is NR4A2 dependent.

Quinolone-Induced Painful Peripheral Neuropathy: A Case Report and Literature Review.

We present a case report of a 20-year-old male with diabetes mellitus type 1, who developed severe painful peripheral neuropathy while on the second of a 10-day course with levofloxacin for the treatment of epididymitis. The intensity of the pain rapidly reached scores of 10/10 in a numeric scale 0/10, and the patient was transferred to an inpatient pain unit where he was treated aggressively with minimal improvement. A skin biopsy revealed small fiber neuropathy. Then the patient was treated with intravenous immunoglobulin, which improved the pain. Now the patient is on outpatient intravenous immunoglobulin infusions bimonthly and making a slow recovery.

Narrative Review on Different Clinical Aspects of Thrombocytopenia

This review article aims to summarize the major causes of thrombocytopenia and characterize the main general symptoms of thrombocytopenia. As well we summarize the diagnosis and treatment methods. We conducted the search using electronic biomedical databases such as; Medline, and Embase, for studies published up to September 2017 in the English language concerning the thrombocytopenia in general. Thrombocytopenia can either be primary or secondary, in that it could go along with a broad spectrum of syndromes and diseases and may be triggered by different systems. Trigger investigation and recognition might be important and sometimes life-saving as in TTP, heparin-induced thrombocytopenia, acute leukemia or perhaps severe ITP. Taking a detailed history and a thorough physical examination can give clues concerning possible underlying illness and clinical treatments. Cautious evaluation of the peripheral blood smear is necessary. When the differential diagnosis is problematic, sometimes a short trial of therapy could help to clarify the reason. For instance, it might be difficult to differentiate inherited thrombocytopenia (without a family history) from immune thrombocytopenia (ITP); in this example, intravenous immunoglobulin infusion will likely have no effect in inherited thrombocytopenia, however, will generally be useful in ITP.

False positive serum levels of (1–3)-ß-D-Glucan after infusion of intravenous immunoglobulins and time to normalisation

(1-3)-ß-D-Glucan (BDG) is a marker for invasive fungal diseases (IFD). Administration of intravenous immunoglobulin preparations (IVIG) has been reported to lead to false positive BDG serum levels >80pg/ml. The aim of the study was to determine the time interval between IVIG infusion and normalisation of BDG serum levels. In 22 paediatric haemato-/oncologic patients, we analysed 92 BDG serum levels obtained within 4 weeks after IVIG administration (0.5 to 1g/kg body weight), correlated them to 54 IVIG episodes and compared them to 76 BDG levels obtained in 29 patients without IVIG administration in the 4 weeks prior to BDG analyses (control group). BDG peak levels within 3 days after IVIG ranged from 21.47 to 660.38 (median 201.4) pg/ml. BDG serum levels at 7, 14 and 21 days (+/-1 day each) after IVIG infusion were significantly higher than BDG serum levels in the control group (p<0.001 each). By days 7, 14, and 21 (+/-1 day each) after IVIG infusion, BDG serum levels have normalized (<80pg/ml) in 64.0%, 76.5% and 100%, respectively. IVIG administration leads to false positive BDG levels in the vast majority of patients. Elevated BDG levels may be detectable for more than two weeks after IVIG administration, while BDG levels normalized within 3 weeks in all patients. Therefore, BDG should not be used to diagnose IFD within three weeks after IVIG administration.

Passive blood anaphylaxis: subcutaneous immunoglobulins are a cause of ongoing passive anaphylactic reaction

BackgroundAllergic, especially anaphylactic, reactions during immunoglobulin replacement therapy are rare, but their pathophysiology and classification remain ambiguous. Recent findings show positive results of skin tests with commercially available immunoglobulins, but target antigens and responsible compounds of the tested immunoglobulins have not been strictly identified.Case description and findingsFour adult patients with recently diagnosed common variable immunodeficiency qualified for standard subcutaneous immunoglobulin replacement therapy regimen. They had no history of receiving immunoglobulins, blood or blood product transfusions. Edema, confluent wheals and erythema were observed at the site of subcutaneous immunoglobulin infusion: typical early and late phase reaction. A transient increase in various passively transferred IgG and IgE antibodies was responsible for misleading positive outcome of the serological testing for active humoral response such as type I allergy, anti-Rh, isohemagglutinins and rheumatoid factor (RF). Although the clinical presentation was very unusual and severe, the retrospective analysis showed no isohemagglutinins, RF and IgE in the patients’ serum before but it was positive after the infusion (median IgE = 18 IU/ml, RF = 8 IU/ml). Type I allergic reaction (laryngeal edema, rhinoconjuctivitis) came out at +14 days of replacement therapy when the patient visited countryside. In the second patient anaphylactic reaction was observed 5 days after ScIg administration, and only when the patient consumed peanuts. Therefore, IgE concentration was measured retrospectively in a series of commercial preparations used in the initial subcutaneous immunoglobulin replacement therapy that caused the adverse event (AE) and it was determined between 138 and 232 IU/ml (kU/l), i.e. 690–2100 IU per g of protein. Specific IgE was within a wide range from 198 (mix of food) to 2809 kUA/l (mix of grass) but many of the tested allergen-specific IgE were class 2 or 3 (i.e. 0.71–17.5 kUA/l).ConclusionsThe case resembles passive cutaneous anaphylaxis and Prausnitz–Küstner reaction but clinical significance of the classical phenomena has not yet been described. This observation indicates that anaphylactic reactions during immunoglobulin replacement therapy may result from IgE or pathological IgG content. Such IgE presence was sporadically reported (34.5–105 IU/ml, i.e. 862.5–1450 IU/g of protein) in intravenous immunoglobulins that are used and monitored by healthcare professionals. In clinical practice the definition of adverse events is inadequate since individual batches of immunoglobulins come with different specificity therefore, they should be classified as transfusion products (not bioequivalents). Such new approach implies establishing (1) new control methods and strategies to ensure introduction of the safety regulations for subcutaneous home self-administration of immunoglobulins as well as (2) guidelines for the prevention of anaphylaxis in patients receiving immunoglobulins (for example peanut).

Recombinant human hyaluronidase-facilitated subcutaneous immunoglobulin infusion in primary immunodeficiency diseases.

Most primary immunodeficiency diseases (PIDDs) resulting in antibody deficiency require intravenous or subcutaneous immunoglobulin G (SCIG) replacement therapy. The flow and distribution of SCIG to the vasculature is impeded by the glycosaminoglycan hyaluronan in the extracellular matrix, which limits the infusion rate and volume per site, necessitating frequent infusions and multiple infusion sites. Hyaluronidase depolymerizes hyaluronan and is a spreading factor for injectable biologics. Recombinant human hyaluronidase (rHuPH20) increases SCIG absorption and dispersion. In patients with PIDD, SCIG facilitated with rHuPH20 (IGHy) has been shown to prevent infections, be well-tolerated and reduce infusion frequency and number of infusion sites as compared with conventional SCIG. This article reviews IGHy clinical studies and real-world practice data in patients with PIDD.

Association of hemolysis with high dose intravenous immunoglobulin therapy in pediatric patients: An open-label prospective trial

Immunoglobulin therapy can be used to treat a wide variety of diseases. However, intravenous immunoglobin products can cause several adverse reactions, including hemolysis. The objective of this study was to determine the extent of anemia and hemolysis after high dose intravenous immunoglobin (2g/kg) and its relationship to the ABO blood type system and hemolytic anemia blood parameters in pediatric patients.Incidence of ‘Intravenous immunoglobulin related hemolysis’ was %19 (6/31) after high dose intravenous immunoglobulin therapy. The blood parameters were measured before IVIG infusion (1–24h before infusion) and 3–10 days after the first day of infusion. In terms of decrease in Hb levels; decline of <1g/dL was detected in 25 patients (80.6%), ≥1g/dL in 2 patients (6.5%) and >2g/dL (severe hemolysis) in 4 patients (12.9%) after infusion. The decrease in hemoglobin, haptoglobin levels, the increase of reticulocyte count or direct bilirubin were statistically significant after infusion. Five of 6 hemolysis patients had non-O blood group, however statistically significant difference was not noted between these two groups. Also, intravenous immunoglobulin-related hemolysis was determined significantly higher in female than male patients. ConclusionMild to moderate hemolysis may be undetected after infusion and the true incidence of such reactions is difficult to document without careful clinical and laboratory follow-up. A careful risk assessment analysis should be performed before intravenous immunoglobulin infusion.

Importance of neonatal immunoglobulin transfer for hippocampal development and behaviour in the newborn pig.

Neurological disorders are among the main clinical problems affecting preterm children and often result in the development of communication and learning disabilities later in life. Several factors are of importance for brain development, however the role of immunoglobulins (passive immunity transfer) has not yet been investigated. Piglets are born agammaglobulinemic, as a result of the lack of transfer of maternal immunoglobulins in utero, thus, they serve as an ideal model to mimic the condition of immunoglobulin deficiency in preterm infants. Thirty six, unsuckled newborn piglets were fed an infant formula or colostrum and supplemented orally or intravenously with either species-specific or foreign immunoglobulin and then compared to both newborn and sow-reared piglets. Two days after the piglets were born behavioural tests (novel recognition and olfactory discrimination of conspecifics scent) were performed, after which the piglets were sacrificed and blood, cerebrospinal fluid and hippocampi samples were collected for analyses. Both parameters of neuronal plasticity (neuronal maturation and synapse-associated proteins) and behavioural test parameters appeared to be improved by the appearance of species-specific porcine immunoglulin in the circulation and cerebrospinal fluid of the piglets. In conclusion, we postulate possible positive clinical effects following intravenous infusion of human immunoglobulin in terms of neuronal plasticity and cognitive function in preterm infants born with low blood immunoglobulin levels.

Novel variant of common variable immunodeficiency

A 57-year-old woman with frequent respiratory infections was initially diagnosed with IgG subclass deficiency based on low levels of IgG subclasses 2 and 3. Three years later, she progressed to...

Disseminated Bacillus Calmette-Gu\xe9rin (BCG) infections in infants with immunodeficiency

BackgroundThe Bacillus Calmette-Guérin (BCG) preparations are live-attenuated derivatives of Mycobacterium bovis. These products are used to vaccinate infants at birth, a practice that may result in a disseminated infection in those patients who have an unidentified immunodeficiency.Case presentationPatients who were immunized at birth with BCG and who developed a disseminated infection are reported here to emphasize the importance of taking an extensive medical history before ‎giving the BCG vaccine. Patient 1 has a sibling who had familial hemophagocytic lymphohistiocytosis. Patient 2 has a severe immunodeficiency with profound lymphopenia. Patient 3 has a sibling who had a disseminated BCG infection. Patient 4 has two siblings with an immunodeficiency disorder; one sibling passed away in infancy and one is receiving regular immunoglobulin infusions. Patient 5 has profound lymphopenia and his brother had cytomegalovirus (CMV) pneumonitis and passed away in infancy.ConclusionsThese unfortunate events could have been avoided by compiling the relevant clinical and laboratory information. These cases also underscore the importance of a strict adherence to the BCG vaccine policies. Local and international registries that estimate the birth prevalence of primary immune deficiencies are needed prior to implementing universal BCG vaccination administration.

Has Articular Involment Lessened in Kawasaki Disease?

ObjectiveKawasaki disease (KD) is an acute systemic vasculitis affecting medium-sized arteries, particularly the coronary arteries. Classic diagnosis is based in prolonged fever and different clinical features, including acute arthritis. Our objective is to determine the prevalence of arthritis at the moment of the diagnosis, the response to intravenous immunoglobulin infusion and the relation with cardiac findings. Material and methodsRetrospective study through review of medical records of 42 patients with KD from 1988 to 2013. Demographic, clinical, laboratory variables and treatment were reviewed. ResultsMale sex was predominant (57%). Fever (100%), exanthema (92.9%), conjunctivitis (78.6%), oropharingeal changes (76.2%), cervical lymphadenopathy (71.4%), edema (52.4%) and peripheral desquamation (46.3%) were reported. Eight patients presented ecocardiography alterations (ectasia and aneurism). Acute articular involvement was reported in 7 (16%) patients, including oligoarticular (57%), monoarticular (29%) and polyarticular (14%) patterns. All patients had elevation of acute phase reactants with neutrophilia (57%) and hypoalbuminemia (71.5%), but showed a good therapeutic response to intravenous immunoglobulin, without sequelaes. Sixteen patients had incomplete KD nine males, with 100% of fever exanthema (75%), conjunctivitis (56%) and 50% of cervical lymphadenopathy. Whereas oropharingeal changes and edemas was described in 44% and 25% of them. Four patients with incomplete KD had coronary artery abnormalities. ConclusionsAcute arthritis was an uncommon finding (16%) and resulted in no sequelae. Maybe the treatment with intravenous immunoglobulin and aspirin prevents the development of articular abnormalities and then leading to a decrease in its follow-up requirement by reumathologist. The cardiovascular sequelae, mainly incomplete KD, remains determining its prognosis. The presence of articular involvement seems not to have influence over cardiac involvement.

The lack of BTK does not impair monocytes and polymorphonuclear cells functions in X-linked agammaglobulinemia under treatment with intravenous immunoglobulin replacement.

The lack of BTK in X-linked agammaglobulinemia (XLA) patients does not affect monocytes and polymorphonuclear cells (PMN) phenotype and functions. In this study, we show that XLA patients had an increased frequency of the intermediate monocytes subset and that BTK-deficient monocytes and PMN had a normal expression of receptors involved in the activation and cellular responses. We demonstrate that BTK is not required for migration, phagocytosis and the production of reactive oxygen species (ROS) following engagement of FC gamma receptors (FcγR). XLA monocytes and PMN showed an efficient calcium (Ca2+)-independent activation of oxidative burst, suggesting that oxidative burst is less dependent by Ca2+ mobilization. The phagocytosis was functional and it remained unaltered also after Ca2+ chelation, confirming the independence of phagocytosis on Ca2+ mobilization. Intravenous immunoglobulin (IVIg) infusion exerted an anti-inflammatory effect by reducing the frequency of pro-inflammatory monocytes. In monocytes, the IVIg reduce the oxidative burst and phagocytosis even if these functions remained efficient.

Severe acute respiratory distress syndrome induced by influenza compared with other viral infections and effects of intravenous immunoglobulin infusion therapy in Vietnamese children

Severe acute respiratory distress syndrome induced by influenza compared with other viral infections and effects of intravenous immunoglobulin infusion therapy in Vietnamese children

Antenatal management in fetal and neonatal alloimmune thrombocytopenia: a systematic review

AbstractSeveral strategies can be used to manage fetal or neonatal alloimmune thrombocytopenia (FNAIT) in subsequent pregnancies. Serial fetal blood sampling (FBS) and intrauterine platelet transfusions (IUPT), as well as weekly maternal IV immunoglobulin infusion (IVIG), with or without additional corticosteroid therapy, are common options, but optimal management has not been determined. The aim of this systematic review was to assess antenatal treatment strategies for FNAIT. Four randomized controlled trials and 22 nonrandomized studies were included. Pooling of results was not possible due to considerable heterogeneity. Most studies found comparable outcomes regarding the occurrence of intracranial hemorrhage, regardless of the antenatal management strategy applied; FBS, IUPT, or IVIG with or without corticosteroids. There is no consistent evidence for the value of adding steroids to IVIG. FBS or IUPT resulted in a relatively high complication rate (consisting mainly of preterm emergency cesarean section) of 11% per treated pregnancy in all studies combined. Overall, noninvasive management in pregnant mothers who have had a previous neonate with FNAIT is effective without the relatively high rate of adverse outcomes seen with invasive strategies. This systematic review suggests that first-line antenatal management in FNAIT is weekly IVIG administration, with or without the addition of corticosteroids.