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Am. J. Trop. Med. Hyg., 76(4), 2007, pp. 737-742
Copyright © 2007 by The American Society of Tropical Medicine and Hygiene

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THROMBOCYTOPENIA ASSOCIATED WITH DENGUE HEMORRHAGIC FEVER RESPONDS TO INTRAVENOUS ADMINISTRATION OF ANTI-D (RH0-D) IMMUNE GLOBULIN

REYNALDO ANGELO C. DE CASTRO, JO-ANNE A. DE CASTRO, MARIE YVETTE C. BAREZ, MELCHOR V. FRIAS, JITENDRA DIXIT, AND MAURICE GENEREUX*
De la Salle University Health Sciences Campus, Far Eastern University, Pediatric Hematology Philippine Children’s Medical Center and Department of Pediatrics, and A. Rodriguez Medical Center, Manila, Philippines; Department of Microbiology, Pamantasan ng Lungsod ng Maynila and Perpetual University, Manila, Philippines; Cangene Corporation, Winnipeg, Manitoba, Canada; Infectious Diseases Department, Davao Medical Center, and Davao Medical School Foundation, Bajada Davao City, Philippines

Severe thrombocytopenia and increased vascular permeability are two major characteristics of dengue hemorrhagic fever (DHF). An immune mechanism of thrombocytopenia due to increased platelet destruction appears to be operative in patients with DHF (see Saito et al., 2004, Clin Exp Immunol 138: 299–303; Mitrakul, 1979, Am J Trop Med Hyg 26: 975–984; and Boonpucknavig, 1979, Am J Trop Med Hyg 28: 881–884). The interim data of two randomized placebo controlled trials in patients (N = 47) meeting WHO criteria for dengue hemorrhagic fever (DHF) with severe thrombocytopenia (platelets ≤ 50,000/mm3) reveal that the increase in platelet count with anti-D immune globulin (WinRho® SDF), 50 µg/kg (250 IU/kg) intravenously is more brisk than the placebo group. The mean maximum platelet count of the anti-D–treated group at 48 hours was 91,500/mm3 compared with 69,333/mm3 in the placebo group. 75% of the anti-D–treated group demonstrated an increase of platelet counts ≥ 20,000 compared with only 58% in the placebo group. These data suggest that treatment of severe thrombocytopenia accompanying DHF with anti-D may be a useful and safe therapeutic option.

Received September 1, 2006. Accepted for publication December 9, 2006.

Acknowledgments: The authors extend their gratitude to Dr. Alba, Dr. Gorospe, and Dr. Masigan, the housestaff of De la Salle University Health Sciences, Manila, Philippines, who were instrumental in the conduct of the study in the pediatric populations.

Disclosure: Maurice Genereux and Jitendra Dixit are full-time employees of Cangene Corporation, manufacturers of the anti-D immune globulin WinRho® SDF. This statement is made in the interest of full disclosure and not because the authors consider this to be a conflict of interest.

* Address correspondence to Maurice Genereux, Cangene Corporation, Winnipeg, Manitoba, Canada R3Y 1G4. E-mail: mgenereu{at}cangene.com.

Authors’ addresses: Reynaldo Angelo C. de Castro, De la Salle University Health Sciences Campus, Manila, Philippines, and Far Eastern University NRMF, Pediatric Hematology, Manila, Philippines, Philippine Children’s Medical Center and Department of Pediatrics, Manila, Philippines, A. Rodriguez Medical Center, Manila, Philippines. Jo-Anne A. de Castro, Department of Microbiology at the Pamantasan ng Lungsod ng Maynila, De la Salle University Health Sciences Campus, and Perpetual University, Manila, Philippines. Marie Yvette C Barez, Davao Medical Center and Davao Medical School Foundation, Bajada Davao City, Philippines. Melchor V. Frias, De la Salle University Health Sciences Campus, Manila, Philippines. Jitendra Dixit and Maurice Genereux, Cangene Corporation, Winnipeg, Manitoba, Canada R3Y 1G4, Telephone: +1 (204) 275-4368, Fax: +1 (204) 487-4086, E-mail: mgenereu{at}cangene.com.

Request for reprints: Maurice Genereux, Cangene Corporation, Winnipeg, Manitoba, Canada R3Y 1G4, E-mail: mgenereu{at}cangene.com.




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E. M. Dimaano, M. Saito, S. Honda, E. A. Miranda, M. T. G. Alonzo, M. D. Valerio, C. A. Mapua, S. Inoue, A. Kumaori, R. Matias, 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, December 1, 2007; 77(6): 1135 - 1138.
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Copyright © 2007 by the American Society of Tropical Medicine and Hygiene.