Andrew M, Blanchette V S, Adams M, Ali K, Barnard D, Chan K W, DeVeber L B, Esseltine D, Israels S, Korbrinsky N
Department of Pediatrics, McMaster University Medical Center, Hamilton, Ontario, Canada.
J Pediatr. 1992 Apr;120(4 Pt 1):522-7. doi: 10.1016/s0022-3476(10)80001-0.
We evaluated the effects of the intravenous administration of anti-D, an immune globulin directed at the D antigen on erythrocytes that is purified from plasma from sensitized persons, on patients with idiopathic thrombocytopenic purpura. To determine the most effective dose, the duration of response, and the side effects of this therapy in children, we performed a multicenter cohort study of escalating doses of intravenously administered anti-D in children aged 1 to 18 years with chronic idiopathic thrombocytopenic purpura, defined as idiopathic thrombocytopenic purpura persisting for more than 6 months with a platelet count of less than 50 x 10(9) cells/L. Twenty-five Rh-positive children received increasing doses of anti-D as follows: day 1, 25 micrograms/kg; day 2, 25 micrograms/kg; day 7, 35 micrograms/kg; day 14, 45 micrograms/kg; and day 21, 55 micrograms/kg. Administration of anti-D was stopped after day 21 or when the platelet count rose to greater than 150 x 10(9) cells/L or the hemoglobin level was 100 gm/L. Platelet count was less than 50 x 10(9) cells/L in all children before treatment. A response was defined as an increase in the platelet count to more than 50 x 10(9)/L and a doubling of the pretreatment platelet count. Of 25 children, 23 (92%) had responses by day 7 of the initial treatment protocol. Eighteen children (72%) had platelet counts greater than 150 x 10(9) cells/L by day 7 after two doses of anti-D. Median duration of response was 5 weeks (range 1 to 24 weeks). Average drop in hemoglobin level was 13.7 gm/L; in one child (a nonresponder) hemoglobin value fell to less than 100 gm/L. No other untoward side effects were seen. Of the 23 children who responded, 21 were retreated with one dose of anti-D when platelet counts returned to baseline values of less than 50 x 10(9) cells/L; all but three of the children who underwent retreatment showed a response the second time. Sixteen children continued to receive intermittent anti-D therapy after completion of the study, and all continued to have excellent responses. We conclude that anti-D is a safe, effective, and relatively inexpensive therapy for childhood chronic idiopathic thrombocytopenic purpura.
我们评估了静脉注射抗-D（一种从致敏者血浆中纯化的针对红细胞D抗原的免疫球蛋白）对特发性血小板减少性紫癜患者的影响。为了确定该疗法在儿童中的最有效剂量、反应持续时间和副作用，我们对1至18岁患有慢性特发性血小板减少性紫癜（定义为特发性血小板减少性紫癜持续超过6个月且血小板计数低于50×10⁹个细胞/L）的儿童进行了一项关于递增剂量静脉注射抗-D的多中心队列研究。25名Rh阳性儿童接受了递增剂量的抗-D，具体如下：第1天，25微克/千克；第2天，25微克/千克；第7天，35微克/千克；第14天，45微克/千克；第21天，55微克/千克。在第21天之后或当血小板计数升至大于150×10⁹个细胞/L或血红蛋白水平为100克/升时停止抗-D给药。所有儿童治疗前血小板计数均低于50×10⁹个细胞/L。反应定义为血小板计数增加至大于50×10⁹/L且预处理血小板计数翻倍。在25名儿童中，23名（92%）在初始治疗方案的第7天出现反应。18名儿童（72%）在两剂抗-D治疗后的第7天血小板计数大于150×10⁹个细胞/L。反应的中位持续时间为5周（范围1至24周）。血红蛋白水平平均下降13.7克/升；1名儿童（无反应者）血红蛋白值降至低于100克/升。未观察到其他不良副作用。在23名有反应的儿童中，当血小板计数恢复到低于50×10⁹个细胞/L的基线值时，21名儿童接受了一剂抗-D的再次治疗；除3名儿童外，所有接受再次治疗的儿童第二次均出现反应。16名儿童在研究完成后继续接受间歇性抗-D治疗，且所有儿童继续有良好反应。我们得出结论，抗-D是治疗儿童慢性特发性血小板减少性紫癜的一种安全、有效且相对廉价的疗法。
