Status:
Ready to upload
Record number:
1922
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Infrequent, not rare. Study estimated a IGIV related hemolysis rate of 1.6%. Sixteen cases of hemolysis were identified of about 1000 patients receiving IVIG.
Time to detection:
Hemolysis associated with the administration of IVIG was observed from 12 hours to 10 days after the first dose of IVIG, with the nadir Hb level occurring from 1 day to 2 weeks after the last dose of IVIG.
Alerting signals, symptoms, evidence of occurrence:
Hemolysis (in couple of cases requiring transfusions), with decrease in hemoglobin mostly, or lower than expected increase in hemoglobin after red cell transfusion
Demonstration of imputability or root cause:
Positive DAT for most cases (14 of 16 or 88%); Anti-A or anti-B antibodies were detected in patients’ plasma and/or eluate in 10 of 16 (63%) cases and corresponded to recipients A/B blood groups.
Imputability grade:
2 Probable
Groups audience:
Keywords:
Suggest new keywords:
IVIG-related hemolysis
Hemoglobin (Hb)
blood group
DAT
Reference attachment:
Suggest references:
Thomas MJ, Misbah SA, Chapel HM, Jones M, Elrington G, Newsom-Davis J. Hemolysis after high-dose intravenous Ig. Blood 1993;82:3789.
Expert comments for publication:
This is a Case Series study of mostly probable IGIV related hemolysis. The study identified the following characteristics in most of the cases: large dose of IVIG, female sex,
non-O blood group, and underlying inflammatory state. The authors suggest in the study that the preponderance of non-O blood group in case series suggests a role for passive transfer of ABO isohemagglutinins in the hemolytic reaction. The authors propose a two step mechanism of IGIV-related hemolysis: sensitization by ABO isohemagglutinins followed by accelerated removal of sensitized RBCs in patients with underlying inflammatory state.