Status:
Ready to upload
Record number:
1176
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Nine hundred-twenty five cases of IVIg-induced hemolysis were identified from a review of cases reported to vigilance groups; 62 case reports were included in the systematic review. The majority of these were due to administration of doses of at least 2 g per kg of IVIg (97%). IVIg-induced hemolysis was reported most commonly for patients with blood group A (65%) or AB (26%). One case report noted that in two patients with IVIg-induced hemolysis both received IVIg from the same batch.
Time to detection:
3 days
Alerting signals, symptoms, evidence of occurrence:
High dose correlation: thrombosis, aseptic meningitis, renal failure, hemolysis. Lower doses adverse events: headache, chills, rigors, backache.
Demonstration of imputability or root cause:
Positive DAT, decreasing hemoglobin concentration, evidence of renal failure. Both patient factors (blood group AB RhD positive) and IVIg-related factors (anti-A level at upper limit of acceptable range) could have played a role in causing the severe hemolysis.
Imputability grade:
1 Possible
Groups audience:
Keywords:
References:
Suggest references:
Desborough, M.J., Miller, J., Thorpe, S.J. Murphy, M.F. and Misbah, S.A. (2013). Intravenous immunoglobulin-induced haemolysis: a case report and review of the literature. Transf Med 24(4): 219-26.
Expert comments for publication:
IVIg may cause extravascular or intravascular hemolysis due to the presence of blood group antibodies. Red blood cells coated with anti-A, anti-B and/or anti-D are removed from the circulation by the macrophages of the reticuloendothelial system, resulting in clinically appreciable hemolysis.