title: Acute renal failure after intravenous anti-D immune globulin in an adult with immune thrombocytopenic purpura.
abstract: Intravenous anti-D immune globulin (anti-D IGIV) is indicated for the treatment of immune thrombocytopenic purpura (ITP) in nonsplenectomized patients who are Rh(D)-positive. Recent reports have described episodes of intravascular hemolysis (IVH) and acute renal failure (ARF) after anti-D IGIV. We report the first adult patient with ITP who required and received dialysis after IVH and ARF complicating treatment with anti-D IGIV. Whether the transfusion of 2 units of Rh(D)-positive red cells, indicated for the resulting anemia, exacerbated the IVH and renal failure is unclear. Three weeks after the administration of anti-D IGIV (13 days after two hemodialysis treatments), the patient's renal function had returned to normal. This case highlights the infrequent but potentially serious side effects of anti-D IGIV and the need to monitor a patient's renal function closely if there is evidence of IVH after infusion of anti-D IGIV. If red cell transfusion is indicated, we recommend the use of Rh(D)-negative red cell products.
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts 01655, USA. ChunN@ummhc.org
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Chun
authors.forename: Bipin
authors.initials: B
authors.lastname: Savani
authors.forename: Richard H
authors.initials: RH
authors.lastname: Seder
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Taplin
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000628:therapy; D017707:Erythrocyte Transfusion / Q000379:methods; D005260:Female; D006456:Hemoglobinuria / Q000139:chemically induced; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications* / Q000188:drug therapy; D006435:Renal Dialysis; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D016756:Immunoglobulins, Intravenous; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin