Changes in CD4/CD8 Ratio and Absolute Neutrophil Count after Intravenous Immunoglobulin Infusion in Pediatric Patients with Immune Thrombocytopenic Purpura

Intravenous immunoglobulin (IVIG) is a plasma derived product. IVIG has been used in treatment of autoimmune, immunodeficiency and infectious diseases. In this study we assessed the effect of intravenous immunoglobulin administration on WBC, neutrophil, lymphocyte and platelet counts as well as the percent of CD4 and CD8 T-cell lymphocytes and number of lymphocytes in pediatric patients with Immune Thrombocytopenic Purpura (ITP). In this cross-sectional study, we analyzed blood samples from 32 patients with ITP few minutes before and 1 hour after completion of IVIG infusion. In all patients platelet count, white blood cell count and differential cell count was performed with Sysmex kx-21 before and after IVIG infusion. The following lymphocyte phenotypic markers of CD4 and CD8 lymphocytes were also examined. Statistical analysis was carried out using paired t-test (p<0.05). Correlation between age and total volume IVIG infused with variables was analyzed with Pearson coefficient correlation. Cellular blood count showed significant decrease in leukocyte (p<0.001), neutrophil (p<0.001) and lymphocyte counts (p<0.001) 1 hour after IVIG infusion, but this changes was not significant in regard to the number of platelets (p=0.377). CD4/CD8 ratio increased significantly after IVIG infusion (p<0.001). Absolute counts of CD4 and CD8 lymphocytes significantly decreased after IVIG treatment (p<0.001). It seems that the IVIG decreases the Absolute Neutrophil Count (ANC) after treatment (without increasing the risk of infection). It can also decrease lymphocyte number. However, changes in the number and percentage of CD4 and CD8 lymphocytes depend on the time of sample collection after IVIG infusion.