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Excerpt
The majority of Rh-positive children with ITP respond to IV anti-D. Higher dose of IV anti-D results in greater platelet (P) response. Immune clearance of anti-D coated autologous RBC by reticuloendothelial cells generally results in a mild drop in hemoglobin; however, the survival of autoantibody coated platelets improve. Mild extravascular hemolysis is seen in the majority of patients. IVH with ARF after IV anti-D treatment has not been previously reported. A child with acute IT? who developed IVH and ARF following infusion of anti-D is presented-SM is a 17-month old Caucasian with new onset acute ITP received 75 μg/kg Anti-D (WinRho® SDF Nabi) IV. A few hours later the child developed fever, vomiting, and lethargy and passed red urine. Pertinent pre and post IV anti-D labs are shown in the table below.
Direct Coombs was positive. On day 5 she was treated with IV hydration and prednisone 2mg/kg/day. Both parents were Rh-positive. Perhaps, higher concentration of anti-D binding sites in homozygous Rh-positive patients activates the complement system and cause IVH. Poor fluid intake coupled with hemoglobinuria due to IVH could have resulted in ARE IV anti-D treatment of IT? should be used with caution.
