RESUMEN
Gammaglobulin treatment was given at a dose of 1 gm/kg/day intravenously in 29 patients with acute idiopathic thrombocytopenic purpura: 15 previously untreated, 10 resistant to steroids, and four who were steroid dependent. The average platelet increase in 24 hours was greater than 50,000/microliter; the average peak platelet count was 194,000/microliter. Eighteen of 25 patients required only one infusion; 10 of these 18 never required any additional (maintenance) therapy. Outcome in previously untreated and steroid-resistant patients was identical; however, previously untreated patients required only 1.8 gm/kg total dose of gammaglobulin, whereas steroid-resistant patients received 3.9 gm/kg. Only one steroid-dependent child of the 29 patients still requires maintenance therapy, at 6-week intervals. Toxicity was minimal. Cost was minimized by not admitting patients and by giving treatment in one visit, rather than five.
Asunto(s)
Inmunización Pasiva , Púrpura Trombocitopénica/terapia , gammaglobulinas/administración & dosificación , Enfermedad Aguda , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Infusiones Parenterales , Masculino , Recuento de Plaquetas , Prednisona/uso terapéutico , Púrpura Trombocitopénica/sangre , Púrpura Trombocitopénica/tratamiento farmacológicoRESUMEN
Intravenous gammaglobulin was used to treat 12 children with chronic immune thrombocytopenic purpura in order to avoid splenectomy. The average rise in platelet count with initial treatment was 226,000/microliters. Currently, one patient is in remission, four patients maintain platelet counts greater than 40,000/microliters without treatment, four patients maintain platelet counts greater than 40,000/microliters with single maintenance infusions of IV IgG at four- or 10-week intervals; three patients did not respond to treatment. In nine of 12 patients, splenectomy was avoided or at least postponed. In responding patients, we were able to discontinue immunosuppressive medication. Platelet count rises with initial IV IgG therapy were correlated with both platelet antibody levels and with a better long-term outcome. Toxicity was minimal.
Asunto(s)
Inmunización Pasiva/métodos , Púrpura Trombocitopénica/terapia , Adolescente , Niño , Preescolar , Enfermedad Crónica , Humanos , Inmunoglobulina G/administración & dosificación , Inmunoglobulina G/análisis , Inmunoglobulina M/análisis , Lactante , Infusiones Parenterales , Recuento de Plaquetas , Púrpura Trombocitopénica/inmunología , Esplenectomía , Factores de TiempoRESUMEN
Platelet-associated IgG was studied in children with acute and chronic ITP and in patients with thrombocytopenic SLE, using the microtiter solid-phase radioimmunoassay. Of the children with acute ITP, 85% had elevated PAIgG levels. The degree of elevation of PAIgG at onset of disease did not correlate with the development of chronicity. Of the children with acute ITP, clinically and hematologically indistinguishable from the rest, 15% had normal PAIgG values. All of 22 children with chronic ITP had elevated PAIgG values. Although there was good correlation between the platelet count and the PAIgG value in children with chronic ITP, the association was not as striking in those with acute ITP; thus, factors in addition to the level of PAIgG may contribute to the thrombocytopenia in the latter group. Patients with SLE and thrombocytopenia had higher values of PAIgG than would be predicted from the platelet count; the PAIgG value is probably not the only factor determining the degree of immune thrombocytopenia.
Asunto(s)
Plaquetas/inmunología , Inmunoglobulina G/análisis , Púrpura Trombocitopénica/sangre , Enfermedad Aguda , Adolescente , Niño , Preescolar , Enfermedad Crónica , Humanos , Lactante , Lupus Eritematoso Sistémico/sangre , Recuento de Plaquetas , Radioinmunoensayo/métodosRESUMEN
A prospective study was carried out to identify the immediate and long-range advantages and disadvantages of a walking-donor transfusion program for an intensive care newborn nursery. The effect of heparin on coagulation of blood was evaluated and found to be minimal. There was no evidence of transmission of HBSAg. The prevalence of CMV infection at the time of follow-up was higher in infants who had received blood from donors seropositive for CMV than in infants who had been transfused from seronegative donors. In our experience, a walking-donor program has been a safe and effective method for the provision of small transfusions of blood to sick neonates.