Inefficacy of intravenous immunoglobulin in patients with low-risk thrombotic thrombocytopenic purpura/hemolytic-uremic syndrome.

Abstract

OBJECTIVE:

To assess the efficacy of intravenous immunoglobulin (IVIG), in comparison with plasma exchange (PE), in the treatment of patients with thrombotic thrombocytopenic purpura/hemolytic-uremic syndrome (TTP/HUS).

DESIGN:

Prospective, nonrandomized comparative study.

SETTING:

Hematology department in a general hospital.

PATIENTS:

17 consecutive adult patients, six of them pregnant, with diagnosis of TTP/HUS. Three had a severity score at diagnosis less than or equal to 4 and were treated with IVIG and 14 had a severity score of greater than or equal to 5 and/or were pregnant and received PE. The response was evaluated after 5 days of therapy.

RESULTS:

Complete remission was obtained in 0/3 cases treated with IVIG and 10/14 (71%) with PE (Fisher's exact test P = 0.05). Three patients died for widespread TTP-HUS, and four had persistent disease. In three of the four resistant patients, complete remission was obtained by further PE but not by further IVIG. The overall remission rate was 76% (13/17).

CONCLUSIONS:

Our study does not confirm the utility of IVIG in the management of TTP-HUS, as suggested by earlier single case reports.

• Authors: G Finazzi, P Bellavita, A Falanga, P Viero, T Barbui
• Journal: American journal of hematology (Am J Hematol) Vol. 41 Issue 3 Pg. 165-9 (Nov 1992) ISSN: 0361-8609 [Print] United States
• PMID: 1415190 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Immunoglobulins, Intravenous

Topics

• Adult
• Aged
• Female
• Hemolytic-Uremic Syndrome (complications, drug therapy, epidemiology)
• Humans
• Immunoglobulins, Intravenous (therapeutic use)
• Male
• Middle Aged
• Pregnancy
• Pregnancy Complications, Hematologic (drug therapy, epidemiology)
• Prospective Studies
• Purpura, Thrombotic Thrombocytopenic (complications, drug therapy, epidemiology)