SHORT REPORT

Anti-D immunoglobulin treatment for thrombocytopenia associated with primary antibody deficiency

H J Longhurst¹, C O'Grady¹, G Evans³, C De Lord⁴, A Hughes⁵, J Cavenagh² and M R Helbert¹

¹ Department of Immunopathology, Barts and The London NHS Trust, London EC1A 7BE, UK
² Department of Haematology, Barts and The London NHS Trust
³ Department of Haematology, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK
⁴ Department of Haematology, Bromley Hospitals NHS Trust, London BR6 8ND, UK
⁵ Department of Haematology, Havering Hospitals NHS Trust, Romford RM3 OBE, UK

Correspondence to:
Correspondence to:
Dr H Longhurst, Department of Immunopathology, St Bartholomew's Hospital, 51–53 Bartholomew Close, London EC1A 7BE, UK;
hlonghurst{at}doctors.org.uk

Aims: To review our experience of anti-D immunoglobulin for immune thrombocytopenia (ITP) in patients with primary antibody deficiency.

Methods/patients: A retrospective case notes review of four Rhesus positive patients with ITP and primary antibody deficiency, treated with anti-D. Patients were refractory to steroids and high dose intravenous immunoglobulin (IVIG). Two patients were previously splenectomised.

Results: All patients responded to anti-D immunoglobulin. Improved platelet counts were sustained for at least three months. Side effects included a fall in haemoglobin in all cases; one patient required red blood cell transfusion. Two patients had transient neutropenia (< 1 x 10⁹/litre).

Conclusion: Anti-D immunoglobulin may be an effective treatment for antibody deficiency associated thrombocytopenia, even after splenectomy. Anti-D immunoglobulin may have considerable clinical advantages in this group of patients, where treatments resulting in further immunosuppression are relatively contraindicated.

Keywords: anti-D immunoglobulin; immune thrombocytopenia; primary antibody deficiency; splenectomy

Abbreviations: CVID, common variable immunodeficiency; ITP, immune thrombocytopenia; IVIG, intravenous immunoglobulin; NA, not applicable

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