Hemolytic transfusion reactions after administration of intravenous immune (gamma) globulin: a case series analysis.
BACKGROUND
This case series summarizes our observations of hemolytic reactions after the administration of large amounts of intravenous immune (gamma) globulin (IVIG).


METHODS
Cases of hemolysis were identified by a decrease in hemoglobin not otherwise explained following IVIG administration.


RESULTS
Sixteen cases were identified over a 2 1/2-year period at the Ottawa Hospital of approximately 1000 patients receiving IVIG (1.6%). Characteristics of these patients include a large dose of IVIG, female sex, non-O blood group, and underlying inflammatory state.


CONCLUSIONS
Significant hemolysis may occur after the administration of large doses of IVIG. A two-step mechanism of hemolysis is proposed, sensitization by ABO isohemagglutinins followed by phagocytosis by activated macrophages. A simple protocol to facilitate the early detection of such cases is presented.
Daw
Zohra
Z
Division of Hematology and Transfusion Medicine, Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.
Padmore
Ruth
R
Neurath
Doris
D
Cober
Nancy
N
Tokessy
Melanie
M
Desjardins
Diane
D
Olberg
Bernhard
B
Tinmouth
Alan
A
Giulivi
Antonio
A
D000017:ABO Blood-Group System; D000328:Adult; D000368:Aged; D000743:Anemia, Hemolytic / Q000453:epidemiology* / Q000209:etiology*; D015415:Biomarkers / Q000097:blood; D004306:Dose-Response Relationship, Immunologic; D005260:Female; D006461:Hemolysis; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution
D000017:ABO Blood-Group System; D015415:Biomarkers; D016756:Immunoglobulins, Intravenous