Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 21 , ISSUE 2 ( 2017 ) > List of Articles

RESEARCH ARTICLE

Safety and efficacy of a single dose of Anti-D (WinRho®) in severe thrombocytopenia secondary to dengue virus infection

Subhash Varma, Nusrat Shafiq, Mayank Singhal, Ashok Pannu

Keywords : Anti-D, dengue, thrombocytopenia

Citation Information : Varma S, Shafiq N, Singhal M, Pannu A. Safety and efficacy of a single dose of Anti-D (WinRho®) in severe thrombocytopenia secondary to dengue virus infection. Indian J Crit Care Med 2017; 21 (2):80-84.

DOI: 10.4103/ijccm.IJCCM_386_16

License: CC BY-ND 3.0

Published Online: 01-02-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Objective: To evaluate the efficacy of a single intravenous (IV) dose of anti-D in severe thrombocytopenia (<20,000) due to dengue virus (DEV) infection. Materials and Methods: An open label, investigator-initiated, randomized interventional study was conducted that included thirty dengue patients (all positive for IgM enzyme-linked immunosorbent assay) with severe thrombocytopenia (<20,000/mm3). Patients were randomized to receive anti-D (50 μg/kg single IV dose) plus supportive therapy or supportive therapy alone. Results: The rate of rise in platelet count was significantly high in the intervention group at 24, 36, and 48 h. At the end of 48 h, 60% patients in the intervention group achieved a platelet count of ≥50,000/mm3 as compared to 6.7% in the control group (P = 0.0019). The requirement of the platelet concentrate infusion in the control group was significantly higher, i.e. 342 ml (±193) as compared to the intervention group requiring only 187 ml (±79). The intervention group showed a significant improvement in bleeding manifestations in all the patients by 24 h in Grade 2 bleed (P = 0.032) and by 48 h in Grade 1 bleed (P = 0.014). Conclusions: Severe thrombocytopenia (≤20,000/mm3) secondary to DEV infection was rapidly and safely reversed by administration of a single dose of 50 μg/kg (250 IU/kg) anti-D IV.


PDF Share
  1. Simmons CP, Farrar JJ, Nguyen V, Wills B. Dengue. N Engl J Med 2012;366:1423-32.
  2. Saito M, Oishi K, Inoue S, Dimaano EM, Alera MT, Robles AM, et al. Association of increased platelet-associated immunoglobulins with thrombocytopenia and the severity of disease in secondary dengue virus infections. Clin Exp Immunol 2004;138:299-303.
  3. Srichaikul T, Nimmannitya S. Haematology in dengue and dengue haemorrhagic fever. Baillieres Best Pract Res Clin Haematol 2000;13:261-76.
  4. La Russa VF, Innis BL. Mechanisms of dengue virus-induced bone marrow suppression. Baillieres Clin Haematol 1995;8:249-70.
  5. Halstead SB. Pathogenesis of dengue: Challenges to molecular biology. Science 1988;239:476-81.
  6. Lei HY, Yeh TM, Liu HS, Lin YS, Chen SH, Liu CC. Immunopathogenesis of dengue virus infection. J Biomed Sci 2001;8:377-88.
  7. Lye DC, Lee VJ, Sun Y, Leo YS. Lack of efficacy of prophylactic platelet transfusion for severe thrombocytopenia in adults with acute uncomplicated dengue infection. Clin Infect Dis 2009;48:1262-5.
  8. Dimaano EM, Saito M, Honda S, Miranda EA, Alonzo MT, Valerio MD, et al. Lack of efficacy of high-dose intravenous immunoglobulin treatment of severe thrombocytopenia in patients with secondary dengue virus infection. Am J Trop Med Hyg 2007;77:1135-8.
  9. Panpanich R, Sornchai P, Kanjanaratanakorn K. Corticosteroids for treating dengue shock syndrome. Cochrane Database Syst Rev 2006;19:CD003488.
  10. Lazarus AH, Freedman J, Semple JW. Intravenous immunoglobulin and anti-D in idiopathic thrombocytopenic purpura (ITP): Mechanisms of action. Transfus Sci 1998;19:289-94.
  11. Brinc D, Lazarus AH. Mechanisms of anti-D action in the prevention of hemolytic disease of the fetus and newborn. Hematology Am Soc Hematol Educ Program 2009;2009:185-91.
  12. de Castro RA, de Castro JA, Barez MY, Frias MV, Dixit J, Genereux M. Thrombocytopenia associated with dengue hemorrhagic fever responds to intravenous administration of anti-D (Rh(0)-D) immune globulin. Am J Trop Med Hyg 2007;76:737-42.
  13. Kharya G, Yadav SP, Katewa S, Sachdeva A. Management of severe refractory thrombocytopenia in dengue hemorrhagic fever with intravenous anti-D immune globulin. Pediatr Hematol Oncol 2011;28:727-32.
  14. World Health Organization. Handbook of Clinical Management of Dengue. WHO Library Cataloguing-in-Publication Data: World Health Organization; 2012. p. 24.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.