1 Department of Pediatrics, Division of Hematology-Oncology, Duke University Medical Center, Durham, North Carolina
The development of platelet alloimmunization is a common and potentially severe consequence in patients who receive frequent platelet transfusions. The use of single-donor pheresis units or human lymphocyte antigen (HLA)-matched platelets to prevent or delay the onset of alloimmunization is often unsuccessful. Once sensitization occurs and refractoriness to platelet transfusions develops, patients are at risk of severe bleeding which may be difficult to manage. There has been no reliably effective therapy for such patients once alloimmunization occurs.
High-dose intravenous (IV) immunoglobulin therapy has been used to treat patients with autoimmune thrombocytopenia,1-4 autoimmune neutropenia,5,6 and posttransfusion purpura.7 Because of its success in these disorders, IV immunoglobulin was given to two patients with hemorrhagic symptoms who were refractory to platelet transfusions because of alloimmunization.