Red cell hemolysis following IVIG

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Uncommon but not rare
Time to detection: 
Immediate to within first few days post infusion
Alerting signals, symptoms, evidence of occurrence: 
Symptomatic hemolysis, dropping hct/hgb, +DAT with positive eluate
Demonstration of imputability or root cause: 
+DAT with positive eluate with same specificity as observed in IVIG product
Imputability grade: 
2 Probable
Groups audience: 
Suggest new keywords: 
Suggest references: 
1) Hemolysis in patients with antibody deficiencies on immunoglobulin replacement treatment. Quinti I, et al. Transfusion. 2015 May;55(5):1067-74 2) IVIG--a hemolytic culprit. Pintova S, Bhardwaj AS, Aledort LM. N Engl J Med. 2012 Sep 6;367(10):974-6 3) Acute hemolysis after high-dose intravenous immunoglobulin therapy in highly HLA sensitized patients. Kahwaji J, et al. Clin J Am Soc Nephrol. 2009 Dec;4(12):1993-7
2 more references to be added (EP) - OK
Expert comments for publication: 
It is well known that IVIG can cause hemolysis. This case series adds Rh specificity antibodies, in addition to the well described anti-A or anti-B isohemaglutinins. Other publications have speculated that anti-Rh specificity antibodies can cause hemolysis after IVIG and recommend monitoring hemoglobin 48-72 hours after infusion.