Concurrent intravenous immunoglobulin and platelet transfusion for refractory alloimmune thrombocytopenia in patients undergoing allogeneic hematopoietic stem cell transplantation

Shahzad, Moazzam; Amin, Muhammad Kashif; Nelson, Maggie; Vyas, Abhinav; Al-Ramahi, Joe S.; Ahmed, Nausheen; Bansal, Rajat; Abdelhakim, Haitham; Shune, Leyla; Abdallah, Al-Ola; Singh, Anurag K.; Abhyankar, Sunil H.; McGuirk, Joseph P.; Mushtaq, Muhammad Umair

doi:10.1016/j.htct.2025.103961

home Sumário navigate_before Anterior Atual Seguinte navigate_next

home Sumário

Original article • Hematol., Transfus. Cell Ther. 47 (4) • 2025 • https://doi.org/10.1016/j.htct.2025.103961 linkcopy

Concurrent intravenous immunoglobulin and platelet transfusion for refractory alloimmune thrombocytopenia in patients undergoing allogeneic hematopoietic stem cell transplantation

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background Severe refractory alloimmune thrombocytopenia is a challenging and life-threatening complication in patients with hematologic disorders who are undergoing allogeneic hematopoietic stem cell transplantation. This study aimed to investigate the utility of continuous intravenous immunoglobulin and platelet transfusions as a therapeutic approach for alloimmune thrombocytopenia in patients undergoing allogeneic transplants.

Methods A single-center retrospective analysis was conducted of ten adult allogeneic transplant patients hospitalized with transfusion-refractory alloimmune thrombocytopenia. Intravenous immunoglobulin (2 g/kg) was administered as a slow continuous infusion over 48 h along with a continuous apheresis platelet infusion (one apheresis unit over eight hours). Clinical response was defined as the resolution of bleeding or patients being able to undergo the required procedure without bleeding complications.

Results The median time after the transplant was 27.5 (range: 7-299) days. Myeloablative and reduced-intensity conditioning were performed in 5 (50 %) and 5 (50 %) patients, respectively. The median platelet count at the time of infusion was 4.5 × 10⁹/L. All patients were able to achieve clinical response with the median maximum platelet count within ten days of the infusion being 41.0 × 10⁹/L. The median time to best response was three days with a median platelet count of 27.0 × 10⁹/L.

Conclusions Continuous intravenous immunoglobulin and platelet infusions over 48 h may be able to overcome life-threatening refractory alloimmune thrombocytopenia in transplant patients and may provide a bridging measure until platelet engraftment or for life-threatening hemorrhage or invasive procedures with high bleeding risk.

Keywords
Intravenous immunoglobulin; Platelet transfusion; Refractory alloimmune thrombocytopenia; Allogeneic hematopoietic stem cell transplantation

Variable	Patient ID
	ID-01	ID-02	ID-03	ID-04	ID-05	ID-06	ID-07	ID-08	ID-09	ID-10
Age (years)/Sex	28/F	59/M	52/M	64/F	52/F	23/M	47/F	66/M	64/M	61/M
Days between transplant and IVIG	8	11	299	12	7	149	129	17	40	38
Primary diagnosis	AML	MDS	AML	MDS	AML	AA + MDS	MDS	MDS	MDS	CNL
Type of Allogenic transplant	MUD	MSD	MSD	MUD	MSD	MUD	MUD	MUD	Haplo	Haplo
Conditioning type	MAC	MAC	MAC	RIC	MAC	RIC	MAC	RIC	RIC	RIC
Conditioning regimen	Cy/Bu	Cy/Bu	Cy/Bu	Bu/Flu	Cy/Bu	Cy/Flu/TBI	Cy/Bu	Cy/Flu/Mel	Flu/Mel/TBI	Bu/Flu/Cy
Graft source	BM	PSC	PSC	PSC	PSC	BM	BM	PSC	PSC	PSC
Indication of urgent need of platelet increase	Vaginal bleeding	Epistaxis	Ommaya reservoir placement	Trifusion catheter removal	Intravitreal hemorrhage	Intravitreal hemorrhage	Epistaxis	Melena	Blood loss anemia	Lumbar Puncture
Platelet antibody positive?	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	No	Yes
Platelet count at start of IVIG infusion (x 10⁹/L)	5	3	17	3	3	9	3	4	7	19
Days between IVIG and platelet >10 × 10⁹/L	2	1	0	3	1	1	3	1	1	0
Days between IVIG and platelet 30 × 10⁹/L	5	2	1	13	16	2	NA	6	2	3
Days between IVIG and platelet 50 × 10⁹/L	6	2	2	15	20	112	NA	NA	NA	NA
Maximum platelet count within 10 days	52	55	116	19	16	42	27	40	30	43
Maximum platelet count within 21 days	87	55	116	194	54	42	27	40	30	43
HLA antibodies	Negative	Positive	NA	NA	NA	Negative	Positive	Positive	Negative	Positive

vertical_align_top show_chart

more_horiz close
- image
- translate
- link
- article
- vertical_align_top
- file_download
- show_chart
- image
- translate
- link
- article

location_on

Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH) R. Dr. Diogo de Faria, 775 cj 133, 04037-002, São Paulo / SP - Brasil - São Paulo - SP - Brazil
E-mail: htct@abhh.org.br

rss_feed Acompanhe os números deste periódico no seu leitor de RSS