THROMBOCYTOPENIA ASSOCIATED WITH DENGUE HEMORRHAGIC FEVER RESPONDS TO INTRAVENOUS ADMINISTRATION OF ANTI-D (RH0-D) IMMUNE GLOBULIN.
Author(s): DE Castro RA, DE Castro JA, Barez MY, Frias MV, Dixit J, Genereux M
Affiliation(s): De la Salle University Health Sciences Campus, Far Eastern University, Pediatric Hematology Philippine Children's Medical Center and Department of Pediatrics, and A. Rodriguez Medical Center, Manila, Philippines; Department of Microbiology, Pamantasan ng Lungsod ng Maynila and Perpetual University, Manila, Philippines; Cangene Corporation, Winnipeg, Manitoba, Canada; Infectious Diseases Department, Davao Medical Center, and Davao Medical School Foundation, Bajada Davao City, Philippines.
Publication date & source: 2007-04, Am J Trop Med Hyg., 76(4):737-742.
Severe thrombocytopenia and increased vascular permeability are two major characteristics of dengue hemorrhagic fever (DHF). An immune mechanism of thrombocytopenia due to increased platelet destruction appears to be operative in patients with DHF (see Saito et al., 2004, Clin Exp Immunol 138: 299-303; Mitrakul, 1979, Am J Trop Med Hyg 26: 975-984; and Boonpucknavig, 1979, Am J Trop Med Hyg 28: 881-884). The interim data of two randomized placebo controlled trials in patients (N = 47) meeting WHO criteria for dengue hemorrhagic fever (DHF) with severe thrombocytopenia (platelets </= 50,000/mm(3)) reveal that the increase in platelet count with anti-D immune globulin (WinRho(R) SDF), 50 mug/kg (250 IU/kg) intravenously is more brisk than the placebo group. The mean maximum platelet count of the anti-D-treated group at 48 hours was 91,500/mm(3) compared with 69,333/mm(3) in the placebo group. 75% of the anti-D-treated group demonstrated an increase of platelet counts >/= 20,000 compared with only 58% in the placebo group. These data suggest that treatment of severe thrombocytopenia accompanying DHF with anti-D may be a useful and safe therapeutic option.