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Case Reports
. 2017 Jul;7(3):e197-e200.
doi: 10.1055/s-0037-1607055. Epub 2017 Sep 29.

IVIG-Associated Maternal Pancytopenia during Treatment for Neonatal Alloimmune Thrombocytopenia

Alyssa Herrmann  1   2 , Benjamin J Samelson-Jones  3 , Sami Brake  4 , Renee Samelson  1
Affiliations
Case Reports

IVIG-Associated Maternal Pancytopenia during Treatment for Neonatal Alloimmune Thrombocytopenia

Alyssa Herrmann et al. AJP Rep. 2017 Jul.

Abstract

Background Treatment for neonatal alloimmune thrombocytopenia (NAIT) primarily involves maternal administration of intravenous immunoglobulin (IVIG) therapy and prednisone according to protocols based on risk stratification. While IVIG is generally well tolerated, hematologic side effects are a potential complication. Case We present the successful management of a rare complication of maternal pancytopenia following standard IVIG treatment. Diagnosis was made during routine obstetric exams. Management included reducing IVIG dosage and adding daily prednisone. Additionally, infusion Lots possibly associated with the event were identified and avoided. Interventions resulted in the resolution of pancytopenia and the birth of a healthy infant without thrombocytopenia. Conclusion Pancytopenia is a rare complication of IVIG treatment in women with pregnancies complicated by NAIT. Serial complete blood counts at the time of treatment would allow for early detection and timely management of the patient. Additionally, limiting the number of infusion Lots may decrease the chance of the described complications.

Keywords: IVIG; NAIT; blood count; pancytopenia; prednisone.

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Figures

Fig. 1
Fig. 1
CBC trends with IVIG treatment. Patient received initial IVIG treatment at 19 + 6 wga. Box 1 : 24 + 3 wga, initial detection of pancytopenia. Box 2 : 26 + 3 wga, time of hospital admission. Box 3 : 26 + 6 wga, decreased IVIG (1 g/kg/week and daily 0.5 mg/kg of oral prednisone) and hospital discharge. Box 4 : 33 + 3 IVIG dose increased to 2 g/kg/week with daily prednisone. Box 5 : 37 + 4 wga, scheduled cesarean section. Box 6 : Six weeks postpartum exams. CBC, complete blood count; IVIG, intravenous immunoglobulin; wga, weeks gestational age.
See this image and copyright information in PMC

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