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Intravenous anti-D treatment of immune thrombocytopenic purpura: analysis
of efficacy, toxicity, and mechanism of effect [see comments]
JB Bussel, JN Graziano, RP Kimberly, S Pahwa and LM Aledort
Department of Pediatrics, New York Hospital, New York, NY.
The efficacy, toxicity, and mechanism of effect of intravenous Anti-D
(Winrho) were studied in 43 Rh+ patients with immune thrombocytopenia
purpura (ITP) who had not undergone splenectomy and in three already
splenectomized patients. The mean platelet increase for the 43
nonsplenectomized patients was 95,000/microL (median 43,000/microL).
Children had greater acute platelet responses than did adults. Human
immunodeficiency virus status and duration of thrombocytopenia did not
affect response. Maintenance treatment was given to patients as needed: the
average interval between infusions was 24 days. The three splenectomized
patients had no platelet response whatsoever. Toxicity was minimal;
infusions were completed in less than 5 minutes. The generally accepted
mechanism of effect of Anti-D has been Fc receptor blockade by substitution
of antibody-coated red blood cells for antibody-coated platelets. Evidence
is presented suggesting that the effect of IV Anti-D is not limited to Fc
receptor blockade, including: (1) no correlation of parameters of hemolysis
with platelet increase; (2) a 48- to 72-hour delay before platelet
increase; (3) a tendency of the change in monocyte Fc receptor I expression
to correlate with platelet increase; and (4) increased in vitro production
of antibodies to sheep red blood cells following IV Anti-D infusion.
Volume 77,
Issue 9,
pp. 1884-1893,
05/01/1991
Copyright © 1991 by The American Society of Hematology
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