Alioglu Bulent, Avci Zekai, Ozyurek Emel, Ozbek Namik
Department of Pediatric Hematology, Baskent University Faculty of Medicine, Ankara, Turkey.
J Pediatr Hematol Oncol. 2007 Sep;29(9):636-9. doi: 10.1097/MPH.0b013e318142ac5f.
Intravenous anti-D immunoglobulin (anti-D IVIG) is indicated for the treatment of immune thrombocytopenic purpura (ITP) in nonsplenectomized patients who are Rh(D)-positive. Recent reports have described episodes of intravascular hemolysis after anti-D IVIG. We report an adolescent boy with chronic ITP who required multiple transfusions of erythrocyte suspensions when intravascular hemolysis persisted for 6 months after anti-D IVIG treatment. He did not have hemolytic anemia before treatment. The features of our case suggest that pediatric patients treated with anti-D IVIG for ITP should be closely monitored for signs and symptoms of hemoglobinemia and/or hemoglobinuria, and clinically significant anemia. Our case proposes that persistence of immune hemolysis after this treatment may be related to presence of previously defined predisposing agents like tuberculosis and antituberculous therapy. Our observations suggest that steroid therapy can be effective in patients who developed prolonged hemolytic anemia and neutropenia after anti-D IVIG therapy.
静脉注射抗-D免疫球蛋白（抗-D IVIG）适用于治疗Rh（D）阳性且未行脾切除术的免疫性血小板减少性紫癜（ITP）患者。近期报告描述了抗-D IVIG治疗后发生血管内溶血的病例。我们报告了一名患有慢性ITP的青春期男孩，在抗-D IVIG治疗后血管内溶血持续6个月，期间需要多次输注红细胞悬液。治疗前他没有溶血性贫血。我们病例的特征表明，接受抗-D IVIG治疗ITP的儿科患者应密切监测血红蛋白血症和/或血红蛋白尿的体征和症状以及具有临床意义的贫血。我们的病例表明，该治疗后免疫性溶血持续存在可能与先前确定的易感因素如结核病和抗结核治疗的存在有关。我们的观察结果表明，对于抗-D IVIG治疗后发生长期溶血性贫血和中性粒细胞减少的患者，类固醇治疗可能有效。
