1Department of Internal Medicine & Pediatrics, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI; 2Department of Internal Medicine, Michigan State University, Lansing, MI; and 3Department of Cardiology, Borgess Medical Center, Kalamazoo, MI.
Am J Ther. 2017 Nov/Dec;24(6):e689-e692. doi: 10.1097/MJT.0000000000000373.
Intravenous immunoglobulin (IVIG) is a therapeutic preparation of pooled polyspecific IgG used effectively in immune thrombocytopenic purpura (ITP), autoimmune diseases, and inflammatory diseases. We present a case of a 67-year-old male who presented with diffuse petechiae and was diagnosed with immune thrombocytopenic purpura with platelet count less than 10,000 per milliliter. Treatment was initiated with IVIG. When the third dose of IVIG was being administered he developed hypertensive urgency and non-ST segment elevation myocardial infarction. He was deemed not to be a candidate for cardiac catheterization and was treated conservatively. IVIG can cause major thrombotic adverse events such as deep vein thrombosis, myocardial infarction and stroke, which are attributed to thrombosis and hyperviscocity. Decreasing the dosage of IVIG, administration of anticoagulants are proposed treatments for such events. We propose that patients receiving high-dose IVIG with previous coronary artery disease require meticulous cardiac monitoring. Further research is needed to determine the true adverse effects of high-dose IVIG and prophylaxis regimens to decrease the risk.
静脉注射免疫球蛋白（IVIG）是一种汇集的多特异性 IgG 的治疗制剂，在免疫性血小板减少性紫癜（ITP）、自身免疫性疾病和炎症性疾病中有效。我们报告了一例 67 岁男性患者，其出现弥漫性瘀点，诊断为血小板计数低于每毫升 10,000 的免疫性血小板减少性紫癜。给予 IVIG 治疗。当给予第三剂 IVIG 时，他发生了高血压急症和非 ST 段抬高型心肌梗死。他被认为不适合进行心脏导管插入术，因此进行了保守治疗。IVIG 可引起重大血栓栓塞不良事件，如深静脉血栓形成、心肌梗死和中风，这归因于血栓形成和高粘度。减少 IVIG 的剂量、给予抗凝剂是此类事件的治疗方法。我们建议，患有既往冠状动脉疾病的接受高剂量 IVIG 的患者需要进行精心的心脏监测。需要进一步研究以确定高剂量 IVIG 的真实不良反应和预防方案以降低风险。
