Immune thrombocytopenia: effects of maternal gamma globulin infusion on maternal and fetal serum, platelet, and monocyte IgG.

A 24-year-old woman with lupus-like serologic abnormalities had immune thrombocytopenia that resolved after splenectomy, but increased quantities of platelet surface IgG persisted. Three years later, during the 36th week of her first pregnancy, gamma globulin (400 mg/kg daily for 5 days) was administered intravenously to decrease the risk and/or severity of immune thrombocytopenia in her infant. The infusion produced marked but transient elevations of maternal concentrations of serum IgG and quantities of monocyte surface IgG, but no significant changes in Fc receptor-mediated rosetting of peripheral blood monocytes with antibody-sensitized platelets occurred. Modest increases in quantities of platelets and plasma platelet-specific IgG were demonstrated. The infant, delivered by cesarean section 2 days after the end of the infusion, had a normal platelet count; cord blood had a normal concentration of serum IgG, but an elevated quantity of platelet surface IgG (by comparison with values for normal adults). Infant values of plasma platelet-specific IgG, monocyte surface IgG, and monocyte/platelet rosettes also were within the range of normal for adults. Anticytomegalovirus antibody was present in large amounts in the gamma globulin infused, first appeared in maternal serum after therapy, and was detected in cord serum. The significance of these observations to the management of immune neonatal thrombocytopenia is discussed.

[1]  A. Lobuglio,et al.  In vitro effects of gammaglobulin (IgG) on human monocyte Fc receptor function. I. Effect on monocyte membrane‐associated IgG and Fc receptor‐dependent binding of antibody‐coated platelets , 1986, American journal of hematology.

[2]  R. Kimberly,et al.  Treatment of refractory immune thrombocytopenic purpura with an anti-Fcγ-receptor antibody , 1986 .

[3]  C. Pappas.  PLACENTAL TRANSFER OF IMMUNOGLOBULINS IN IMMUNE THROMBOCYTOPENIC PURPURA , 1986, The Lancet.

[4]  E. Besa,et al.  High‐dose intravenous igg in the management of pregnancy in women with idiopathic thrombocytopenic purpura , 1985, American journal of hematology.

[5]  R. Troncone,et al.  Treatment of neonatal passive immune thrombocytopenia. , 1984, The Journal of pediatrics.

[6]  L. Wadsworth,et al.  High-dose intravenous therapy with immune globulin before delivery for idiopathic thrombocytopenic purpura. , 1984, Canadian Medical Association journal.

[7]  B. Curfman,et al.  Intravenous immunoglobulin in neonatal group B streptococcal disease. Pharmacokinetic and safety studies in monkeys and humans. , 1984, The American journal of medicine.

[8]  R. Sorensen,et al.  Use of intravenous immune globulin in pregnant women with common variable hypogammaglobulinemia. , 1984, The American journal of medicine.

[9]  Newland Ac,et al.  Intravenous IgG for autoimmune thrombocytopenia in pregnancy. , 1984 .

[10]  G. Kerbrat,et al.  Management of immune thrombocytopenia in pregnancy: response to infusions of immunoglobulins. , 1984, American journal of obstetrics and gynecology.

[11]  J. Kelton.  Management of the Pregnant Patient with Idiopathic Thrombocytopenic Purpura , 1983 .

[12]  B. M. Eaton,et al.  Uptake and fate of exogenous immunoglobulin G in the perfused human placenta. , 1983, Journal of reproductive immunology.

[13]  B. Measday,et al.  Autoimmune thrombocytopenia in pregnancy: new approach to management. , 1983, British medical journal.

[14]  G. Shaw,et al.  Immune thrombocytopenic purpura. Use of a 125I-labeled antihuman IgG monoclonal antibody to quantify platelet-bound IgG. , 1983, The New England journal of medicine.

[15]  C. Cunningham-Rundles,et al.  Intravenous gammaglobulin treatment of chronic idiopathic thrombocytopenic purpura , 1983 .

[16]  W. Noyes,et al.  High-dose intravenous immunoglobulin therapy in patients with immune thrombocytopenic purpura. , 1983, JAMA.

[17]  P. Powers,et al.  The prenatal prediction of thrombocytopenia in infants of mothers with clinically diagnosed immune thrombocytopenia. , 1982, American journal of obstetrics and gynecology.

[18]  B. Schmidt,et al.  INCREASED PLATELET-ASSOCIATED IgG IN CHILD ON HIGH-DOSE GAMMAGLOBULIN FOR IDIOPATHIC THROMBOCYTOPENIC PURPURA , 1982, The Lancet.

[19]  J. Fehr,et al.  Transient reversal of thrombocytopenia in idiopathic thrombocytopenic purpura by high-dose intravenous gamma globulin. , 1982, The New England journal of medicine.

[20]  M. Mennuti,et al.  Immune thrombocytopenic purpura and pregnancy. , 1982, The New England journal of medicine.

[21]  S. Karpatkin,et al.  Platelet counts in infants of women with autoimmune thrombocytopenia: effects of steroid administration to the mother. , 1982, The New England journal of medicine.

[22]  S. Karpatkin,et al.  Platelet Counts in Infants of Women with Autoimmune Thrombocytopenia , 1981 .

[23]  U. Budde,et al.  HIGH-DOSE INTRAVENOUS GAMMAGLOBULIN FOR IDIOPATHIC THROMBOCYTOPENIC PURPURA , 1981, The Lancet.

[24]  A. Hirt,et al.  HIGH-DOSE INTRAVENOUS GAMMAGLOBULIN FOR IDIOPATHIC THROMBOCYTOPENIC PURPURA IN CHILDHOOD , 1981, The Lancet.

[25]  C. Boxtel,et al.  Neonatal Alloimmune Thrombocytopenia: Detection and Characterization of the Responsible Antibodies by the Platelet Immunofluorescence Test , 1981 .

[26]  F. Griffin.  Effects of soluble immune complexes on Fc receptor- and C3b receptor- mediated phagocytosis by macrophages , 1980, The Journal of experimental medicine.

[27]  R. Pitkin,et al.  Fetal platelet counts in the obstetric management of immunologic thrombocytopenic purpura. , 1980, American journal of obstetrics and gynecology.

[28]  L. Kernoff,et al.  Neonatal thrombocytopenia complicating autoimmune thrombocytopenia in pregnancy. Evidence for transplacental passage of antiplatelet antibody. , 1979, Annals of internal medicine.

[29]  G. Shaw,et al.  Human lymphocyte, monocyte, and neutrophil antibody-dependent cell-mediated cytotoxicity toward human erythrocytes. , 1978, Cellular immunology.

[30]  D. Douglas.  V.I.P.s IN HOSPITAL , 1975, The Lancet.

[31]  P. R. Betts,et al.  Juvenile nephrono phthisis , 1973 .

[32]  G. Klein,et al.  Cellular localization of an Epstein‐Barr virus (EBV)‐associated complement‐fixing antigen in producer and non‐producer lymphoblastoid cell lines , 1973, International journal of cancer.

[33]  W. Dowdle,et al.  A serologic study of herpesvirus hominis strains by microneutralization tests. , 1967, Journal of immunology.

[34]  W. Henle,et al.  Immunofluorescence in Cells Derived from Burkitt's Lymphoma , 1966, Journal of bacteriology.

[35]  E. H. Lennette,et al.  Immunofluorescent staining in the laboratory diagnosis of varicella-zoster virus infections. , 1965, The Journal of laboratory and clinical medicine.

[36]  Andrews Hl,et al.  The role of the reticuloendothelial system in the pathogenesis of idiopathic thrombocytopenic purpura. , 1965, Transactions of the Association of American Physicians.