Treatment of platelet alloimmunization with intravenous immunoglobulin in a child with aplastic anemia

A 9‐year‐old girl with severe refractory aplastic anemia had become refractory to platelet transfusion due to platelet alloimmunization. As a result, a huge right parieto‐temporo‐occipital cerebral hematoma and a subarachnoid hemorrhage subsequently occurred. Intravenous immunoglobulin (IVIG) (Green Cross, Taiwan) at a dose of 0.4 g/kg/day for 5 days, followed by another 3 doses during the following 5 days, and combined with large‐dose platelet transfusions effectively controlled the bleeding by elevating the platelet count to above 100 × 10³/mm³. The patient soon recovered with only a mild sequela. Two months later, because of multiple caries and a periodontal abscess, dental extraction needed to be performed. IVIG (0.4 g/kg/day × 6 days) enabled surgery to proceed by elevating the platelet count to above 55 × 10³/mm³, and no bleeding complications occurred during or after the procedure. The potential benefit of high‐dose IVIG in modulating platelet alloimmunization is a result of increasing the survival of transfused platelets. Thus, this therapy is recommended when patients with platelet alloimmunization have critical bleeding episodes or undergo surgical procedures. © 1995 Wiley‐Liss, Inc.