Neutropenia as a complication of intravenous immunoglobulin (IVIG) therapyin children with immune thrombocytopenic purpura: common and non-alarming

Following reports on adult patients with neutropenia as a result of adminis tration of intravenous immunoglobulin (IVIG) we have investigated the incid ence and consequences of neutropenia following IVIG treatment in children w ith immune thrombocytopenic purpura (ITP). The medical records of 14 children with ITP who received IVIG as inpatients were reviewed. Past and present history, age, previous medications, comple te blood count and differential before and after treatment with IVIG were r ecorded for each patient. The patients, aged 5.5 +/- 3.5 (0.5-11.5) years [mean +/-SD; range] receive d one or more courses of IVIG, Neutropenia (total neutrophils <2000/mm(3)) was observed within 24 h after the first course of IVIG in five children (3 6%). The pretreatment neutrophil count in this group was not significantly different from that observed in the patients without IVIG-induced neutropen ia (p = 0.98). The condition resolved spontaneously and without complicatio ns in all patients within 48 h. In a preliminary experiment in which bone m arrow derived mononuclear cells were assayed for the clonogenicity in methy lcellulose, there was no suppressive effect of IVIG on the number of CFU-GM colonies. Conclusions: since IVIG is currently administered in a vast number of medic al indications, neutropenia following IVIG administration may not be an unc ommon finding. It seems to be transient and self limited. (C) 1999 Internat ional Society for Immunopharmacology. Published by Elsevier Science Ltd. Al l rights reserved.