Intravenous immunoglobulin–induced acute thrombocytopenia

Anna Gurevich-Shapiro, Lilach Bonstein, Galia Spectre, Nardeen Atweh, Tsipora Gruenewal, Michael Shapiro*, Boaz Tadmor, Pia Raanani

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Intravenous immunoglobulin (IVIG) has known efficacy in various hematologic conditions, including immune thrombocytopenic purpura. STUDY DESIGN AND METHODS: We present the clinical course of a patient with splenic marginal zone lymphoma, who developed acute thrombocytopenia on three consecutive episodes, with nadir counts of 27 × 109, 50 × 109, and 9 × 109/L, upon administration of Intratect IVIG for hypogammaglobulinemia. An immunofluorescence test applying flow cytometry and monoclonal antibody immobilization of platelet antigens (MAIPA) assay were used to evaluate the reaction between IgG present in the IVIG preparations and the patient's or healthy donors' platelets (PLTs). RESULTS: A strong direct binding reaction was observed between the patient's PLTs and Intratect IgG using both methods. A similar reaction failed to materialize with controls. Binding was not antigen specific according to MAIPA. CONCLUSIONS: This is the first reported case of thrombocytopenia as a possible adverse effect of IVIG.

Original languageEnglish
Pages (from-to)493-497
Number of pages5
Issue number2
StatePublished - Feb 2018


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