Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Change of absolute neutrophil count after intravenous immunoglobulin administration for the children with idiopathic thrombocytopenic purpura

특발성혈소판감소성자반증 환아에서 정주용 면역 글로불린 투여 후 절대 호중구 수치의 변화

  • Shin, Hyun Jung (Department of Pediatrics Keimyung University School of Medicine) ;
  • Bang, In Kug (Department of Pediatrics Keimyung University School of Medicine) ;
  • Choe, Byung Kyu (Department of Pediatrics Keimyung University School of Medicine) ;
  • Hwang, Jin-Bok (Department of Pediatrics Keimyung University School of Medicine) ;
  • Kim, Jun Sik (Department of Pediatrics Keimyung University School of Medicine) ;
  • Kim, Heung Sik (Department of Pediatrics Keimyung University School of Medicine)
  • 신현정 (계명대학교 의과대학 소아과학교실) ;
  • 방인국 (계명대학교 의과대학 소아과학교실) ;
  • 최병규 (계명대학교 의과대학 소아과학교실) ;
  • 황진복 (계명대학교 의과대학 소아과학교실) ;
  • 김준식 (계명대학교 의과대학 소아과학교실) ;
  • 김흥식 (계명대학교 의과대학 소아과학교실)
  • Received : 2007.05.19
  • Accepted : 2007.07.17
  • Published : 2007.10.15
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Abstract

Purpose : Intravenous immunoglobulin (IVIG) is effective for the treatment of idiopathic thrombocytopenic purpura (ITP) in children. Recently, several reports have been published that show its impact on the absolute neutrophil count. The present study was performed to confirm these findings. Methods : Data on 26 ITP patients were analyzed. Patients with febrile illness or increased C-reactive protein levels at presentation, which would influence the neutrophil counts, were excluded to determine the sole impact of IVIG. In addition, patients who received steroid treatment were also excluded. Results : Sixteen boys and ten girls were analyzed. For patients who received an IVIG dose of 0.4 g/kg/day (n=17), the absolute neutrophil count (ANC) measured next day was significantly decreased. For patients who received an IVIG dose of 1 g/kg/day (n=9), the ANC measured the next day was also significantly decreased. However, the decrease was more profound in the high-dose group compared to the low-dose group. Among six cases with profoundly decreased ANC greater than $1,000/mm^3$, four patients (67%) received IVIG at a dose of 1 g/kg/day. All four cases with increased ANC were treated with IVIG dose of 0.4 g/kg/day, and three cases (75%) among them had a febrile reaction during IVIG administration. None of the cases with decreased ANC had a febrile reaction. No cases had infectious complications reported. Conclusion : IVIG treatment for ITP patients appears to suppress the ANC. This decrease of ANC was more pronounced when a higher dose of IVIG was used. Some cases with increased ANC counts after IVIG use were found only in low-dose IVIG group, and was associated with febrile reactions during IVIG use.

목 적 : 특발성혈소판감소성자반증의 치료로 정주용 면역 글로불린을 사용한 후 절대 중성구치의 변화에 대하여 조사하였다. 방 법 : 내원 당시 발열이나 CRP 증가, 스테로이드 사용 등 백혈구수치에 영향을 받을 수 있는 인자를 가지지 않은 특발성혈소판감소성자반증 환아 26례를 대상으로 사용된 정주용 면역 글로불린의 용량과 사용중 발열 여부 등에 따라 정주용 면역 글로불린을 1일간 사용한 전후의 절대 중성구 수치의 변화를 후향적으로 관찰하였다. 결 과 : 특발성혈소판감소성자반증의 치료로 면역 글로불린을 사용한 후 1일이 지났을 때 절대 호중구 수치는 감소되었던 경우가 많았고 절대 호중구 수치의 감소 정도는 면역 글로불린의 용량과 관계가 있었다. 면역 글로불린 사용 후 절대 호중구 수치가 증가되었던 경우는 면역 글로불린 사용 중 발열을 동반하거나 저용량의 면역 글로불린을 사용하였던 경우들이었다. 절대 호중구 수치가 감소된 경우에도 감염성 합병증이 있었다고 기술되었던 경우는 찾을 수 없었다. 결 론 : 특발성혈소판감소성자반증의 치료에 면역 글로불린을 사용하고 1일 후 절대 호중구 수치가 감소되는 현상을 관찰할 수 있었다. 심각한 감염성 합병증이 있었다는 기록은 찾기 어려웠으나 이러한 현상이 환자에게 어떤 영향을 미치는지에 대해서는 앞으로 계속 관찰할 필요가 있겠다.

Keywords

References

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