[Effects of intravenous immunoglobulins in thrombopenia related to septic shock]

Intravenous immunoglobulins have been shown to be effective in the treatment of immunologically mediated thrombocytopenia. Several articles have been published on the positive effect of immunoglobulins in sepsis-related death. We retrospectively studied the effects of intravenous immunoglobulins used during septic shock thrombocytopenia over a 5-year period in a polyvalent intensive care unit.

Inclusion criteria were development of acute thrombocytopenia under 75 G/l during septic shock, excluding all cases of disseminated intravascular coagulation. Thirty-five patients were included in the study; 18 were given polyvalent intravenous immunoglobulins (group IgIV) and 17 were not (controls). The two groups were comparable for SAPS and APACHE II gravity scores at admission and at day 0 (first day of septic shock with platelet count under 75 G/l), age, sex, platelet count at admission, OSF score, type of referral unit, McCabe score, and the presence of 4 parameters which might affect platelet count hemofiltration, ARDS, surgery, Swan-Ganz catheter.

Platelet counts increased on day 8 in the treatment group (63.5 G/l, range 25-453 versus 105.7 G/l, range 38-355; p = 0.0505). The number of days with thrombocytopenia was the same in both groups. Overall mortality was high (60%) but there was a difference between the two groups in favor of the treated group (74.7% versus 44.4%; p = 0.053). The number of red cell units (214 vs. 164) and plasma units (175 vs. 54) transfused was higher in the control group. Platelet transfusion was equivalent in the two groups.

Although we were unable to demonstrate a significant difference in the effects of immunoglobulins on platelet level and mortality, the trend during this evaluation was comparable with that reported in the literature. For transfusion, and although the results were not significant, a notion of reduced risk was evident. Prospective trials are needed to confirm these observations.