BACKGROUND AND OBJECTIVES: Intravenous Ig (IVIG) is used in renal transplantation for desensitization and treatment of antibody-mediated rejection (AMR). The infusion of high-dose IVIG is generally well tolerated, but there are reports of hemolytic anemia induced by anti-blood group antibodies present in IVIG. Here, we report our experience with IVIG-induced hemolytic anemia (IH) in ESRD patients receiving IVIG for desensitization or treatment of AMR. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: All patients receiving IVIG for desensitization or for treatment of AMR were monitored for evidence of acute anemia and hemolysis. Markers of hemolysis, including direct antiglobulin tests, were recorded. Five different IVIG products were tested for isohemagglutinin titers. RESULTS: There were 18 cases of IH in 16 patients. All identified cases received the IVIG product Gamunex, Gammagard liquid, or Privigen. All patients developing hemolysis were non-O blood types. Isohemagglutinin titers ranged from 1:2 to 1:64 in the various IVIG products, with higher titers noted in the liquid, nonlyophilized products. CONCLUSIONS: Acute IH is a significant complication of high-dose IVIG infusion. Identified risk factors include non-O blood type of the recipient and administration of liquid IVIG preparations with high titer anti-A/B IgG antibodies. We recommend monitoring hemoglobin 48 to 72 h after IVIG infusion. If the hemoglobin decreases, a hemolytic work-up is recommended. Hemolysis could be avoided in at risk patients by choosing a low titer product. However, other complications such as acute renal failure or thrombosis may be seen because the low titer products are usually hyperosmotic.
BACKGROUND AND OBJECTIVES: Intravenous Ig (IVIG) is used in renal transplantation for desensitization and treatment of antibody-mediated rejection (AMR). The infusion of high-dose IVIG is generally well tolerated, but there are reports of hemolytic anemia induced by anti-blood group antibodies present in IVIG. Here, we report our experience with IVIG-induced hemolytic anemia (IH) in ESRDpatients receiving IVIG for desensitization or treatment of AMR. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: All patients receiving IVIG for desensitization or for treatment of AMR were monitored for evidence of acute anemia and hemolysis. Markers of hemolysis, including direct antiglobulin tests, were recorded. Five different IVIG products were tested for isohemagglutinin titers. RESULTS: There were 18 cases of IH in 16 patients. All identified cases received the IVIG product Gamunex, Gammagard liquid, or Privigen. All patients developing hemolysis were non-O blood types. Isohemagglutinin titers ranged from 1:2 to 1:64 in the various IVIG products, with higher titers noted in the liquid, nonlyophilized products. CONCLUSIONS: Acute IH is a significant complication of high-dose IVIG infusion. Identified risk factors include non-O blood type of the recipient and administration of liquid IVIG preparations with high titer anti-A/B IgG antibodies. We recommend monitoring hemoglobin 48 to 72 h after IVIG infusion. If the hemoglobin decreases, a hemolytic work-up is recommended. Hemolysis could be avoided in at risk patients by choosing a low titer product. However, other complications such as acute renal failure or thrombosis may be seen because the low titer products are usually hyperosmotic.
Authors: James Coghill; Terrance Comeau; Thomas Shea; Linda Braddy; Nicholas Bandarenko; Araba Afenyi-Annan; Donald Harvey Journal: Biol Blood Marrow Transplant Date: 2006-07 Impact factor: 5.742
Authors: Alp Sener; Andrew A House; Anthony M Jevnikar; Neil Boudville; Vivian C McAlister; Norman Muirhead; Faisal Rehman; Patrick P W Luke Journal: Transplantation Date: 2006-01-15 Impact factor: 4.939
Authors: Stanley C Jordan; Dolly Tyan; Don Stablein; Matthew McIntosh; Steve Rose; Ashley Vo; Mieko Toyoda; Connie Davis; Ron Shapiro; Deborah Adey; Dawn Milliner; Ralph Graff; Robert Steiner; Gaetano Ciancio; Shobah Sahney; Jimmy Light Journal: J Am Soc Nephrol Date: 2004-12 Impact factor: 10.121
Authors: Jenny M Despotovic; Michele P Lambert; Jay H Herman; Terry B Gernsheimer; Keith R McCrae; Michael D Tarantino; James B Bussel Journal: Transfusion Date: 2011-10-07 Impact factor: 3.157
Authors: Christine W Bruggeman; Sietse Q Nagelkerke; Wendy Lau; Cedric Manlhiot; Masja de Haas; Robin van Bruggen; Brian W McCrindle; Rae S M Yeung; Taco W Kuijpers Journal: Blood Adv Date: 2020-07-28
Authors: F Dhainaut; P-O Guillaumat; H Dib; G Perret; A Sauger; C de Coupade; M Beaudet; M Elzaabi; L Mouthon Journal: Vox Sang Date: 2012-09-25 Impact factor: 2.144