Alloimmunization From Transfusions Medication

Updated: Sep 08, 2017
  • Author: Douglas Blackall, MD, MPH; Chief Editor: Michael A Kaliner, MD  more...
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Medication

Medication Summary

Immunosuppressive agents such as IVIG can provide short-term benefit in patients with platelet refractoriness resulting from alloimmunization. Consider using cytotoxic agents only in patients clearly unresponsive to all other treatment modalities. Only physicians familiar with the use and toxicity of cytotoxic agents should prescribe these drugs, as there is only anecdotal support for their use in alloimmunization. In other words, this indication is considered investigational.

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Immunosuppressive agents

Class Summary

Inhibit activity of the immune system.

Immunoglobulin intravenous IVIG (Gamunex, Iveegam EN, Gammagard)

Fractionated human immunoglobulins treated to inactivate viruses and filtered to eliminate high molecular weight complexes. Neutralizes circulating myelin antibodies through antiidiotypic antibodies. Promotes remyelination. May increase CSF IgG (10%). Down-regulates proinflammatory cytokines, including INF-gamma. Blocks Fc receptors on macrophages. Suppresses inducer T and B cells and augments suppressor T cells. Blocks complement cascade.

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Cytotoxic agents

Class Summary

Inhibit immune cell growth and proliferation.

Vincristine (Oncovin)

Only one report describes effectiveness in an 18-mo-old child with platelet refractoriness. Several reports, however, describe its use for treating autoimmune thrombocytopenia. Use for platelet alloimmunization remains investigational.

Cyclosporin A (Sandimmune, Neoral)

Two reports describe use in patients with aplastic anemia and platelet refractoriness. Both patients dramatically improved in response to platelet transfusions after treatment. Use for platelet alloimmunization remains investigational.

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