Official Journal of the British Blood Transfusion Society
Transfusion Medicine
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LETTER TO THE EDITOR
Intravenous immunoglobulin induces short-term reversal of drug-induced autoimmune neutropenia Dear Editor, We present a case where intravenous immunoglobulin (IVIG) was used to treat drug-induced autoimmune neutropenia, which did not respond to granulocyte-colony stimulating factor (GCSF). A 71-year-old Caucasian female was admitted with febrile neutropenia and oral mucositis. Two weeks prior she was prescribed Novalgin (a dipyrone-based analgesic) for non-inflammatory musculoskeletal back pain, which she had experienced intermittently. Her only other medication was telmisartan. She had no other past medical history. There were no systemic symptoms to suggest connective tissue disease. Complete blood count revealed haemoglobin 92 g L−1 (120–150 g L−1 ), reticulocytes 50 × 109 L−1 (50–100 × 109 L−1 ), mean corpuscular volume (MCV) 86·2 f L−1 (80–100 f L−1 ), total white cell count 0·9 × 109 L−1 (4–10 × 109 L−1 ), neutrophils 0·0 × 109 L−1 (2–7 × 109 L−1 ), lymphocytes 0·8 × 109 L−1 (1–3 × 109 L−1 ) and platelets 339 × 109 L−1 (150–400 × 109 L−1 ). Blood film confirmed severe neutropenia without other findings. Red cell antibody screen was negative, vitamin B12 346 pmol L−1 (150–750 pmol L−1 ) and red cell folate 1105 nmol L−1 . Infectious disease testing was negative including blood cultures, cytomegalovirus and parvo-virus polymerase chain reaction (PCR), human immunodeficiency virus (HIV), hepatitis B surface antigen and core antibody and hepatitis C serology. Anti-nuclear antibody (ANA) was detected with a speckled pattern at a titer of 1 : 640. Extractable nuclear antigen (ENA) were detected (anti-SS-A and Ro 52) and rheumatoid factor was detected at 20 IU mL−1 (
Transfusion Medicine
|
LETTER TO THE EDITOR
Intravenous immunoglobulin induces short-term reversal of drug-induced autoimmune neutropenia Dear Editor, We present a case where intravenous immunoglobulin (IVIG) was used to treat drug-induced autoimmune neutropenia, which did not respond to granulocyte-colony stimulating factor (GCSF). A 71-year-old Caucasian female was admitted with febrile neutropenia and oral mucositis. Two weeks prior she was prescribed Novalgin (a dipyrone-based analgesic) for non-inflammatory musculoskeletal back pain, which she had experienced intermittently. Her only other medication was telmisartan. She had no other past medical history. There were no systemic symptoms to suggest connective tissue disease. Complete blood count revealed haemoglobin 92 g L−1 (120–150 g L−1 ), reticulocytes 50 × 109 L−1 (50–100 × 109 L−1 ), mean corpuscular volume (MCV) 86·2 f L−1 (80–100 f L−1 ), total white cell count 0·9 × 109 L−1 (4–10 × 109 L−1 ), neutrophils 0·0 × 109 L−1 (2–7 × 109 L−1 ), lymphocytes 0·8 × 109 L−1 (1–3 × 109 L−1 ) and platelets 339 × 109 L−1 (150–400 × 109 L−1 ). Blood film confirmed severe neutropenia without other findings. Red cell antibody screen was negative, vitamin B12 346 pmol L−1 (150–750 pmol L−1 ) and red cell folate 1105 nmol L−1 . Infectious disease testing was negative including blood cultures, cytomegalovirus and parvo-virus polymerase chain reaction (PCR), human immunodeficiency virus (HIV), hepatitis B surface antigen and core antibody and hepatitis C serology. Anti-nuclear antibody (ANA) was detected with a speckled pattern at a titer of 1 : 640. Extractable nuclear antigen (ENA) were detected (anti-SS-A and Ro 52) and rheumatoid factor was detected at 20 IU mL−1 (
