142: Cerebral Thrombosis After Intravenous Immunoglobulin Therapy of Immune Thrombocytopenia
Notice bibliographique
Résumé
Intravenous Immunogloblin (IVIG) is frequently used in the treatment of immune-mediated disorders such as immune thrombocytopenia, inflammatory diseases, and as replacement therapy in immune deficiencies. It is prepared from plasma pooled from thousands of healthy donors and has been used since 1952. It is generally considered safe and secure with acceptable adverse events including headaches, fever, myalgia, urticaria, and nausea. However, rare serious adverse events (SAE) can occur. Over the last decade, IVIG use has dramatically increased across the world. Following one case of IVIG-SAE, we reviewed incidence of such SAE through reports of Quebec Hemovigilance System (QHS). A 16-year-old female presented for severe thrombocytopenia. Given her age and menorrhagia, we choose to give platelet-enhancing agents. She had recurrent episodes of severe thrombocytopenia. First IVIG infusion was followed by severe aseptic meningitis. Given new episode of thrombocytopenia, she received fractionated IVIG infusion which again resulted in normalisation of platelet count, but was complicated within 10 days by hemiparesis and seizures, associated with sinus vein thrombosis. She eventually had a good outcome without minimal sequelae. Through QHS, we found four other reports of thrombotic events possibly related to IVIG therapy, all being adults. Based upon most recent estimates, this corresponded to 0.6% to 1.6% of all reported IVIG-related SAE in QHS. Over a five year period (2005 to 2010), there have been 112 CNS-related events including headaches or aseptic meningitis. The incidence of all reported events further ranged between 1:6683 and 1:9580 events per gram of IVIG given. Since the first report of IVIG-associated thrombosis in 1986, more than one hundred cases have been reported, with only six paediatric cases. Patient's predispositions, such as advanced age, previous thrombotic events, and hypercoagulable state were found to be associated with higher risk of thrombosis. Rapid infusion, high dosage and concentration, have also been implicated. The thrombotic effects of IVIG may be due to contamination with activated coagulation factor XI, arterial vasospasm or increased blood viscosity. ITP has itself been paradoxically recognized as a possible prothrombotic condition. The presence of large platelets with enhanced endothelial adherence, as well as complement activation may partly explain such enhanced thrombotic propensity. Clinicians should have a high suspicion for intracranial complications, including thrombosis, in patients receiving IVIG and history of recurrent headache. IVIG related complications should be thoroughly investigated and properly reported, in order to improve hemovigilance system and study of such rare serious adverse events.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».