title: Hemolytic transfusion reactions after administration of intravenous immune (gamma) globulin: a case series analysis.
abstract: 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.
authors.affiliation: Division of Hematology and Transfusion Medicine, Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Zohra
authors.initials: Z
authors.lastname: Daw
authors.forename: Ruth
authors.initials: R
authors.lastname: Padmore
authors.forename: Doris
authors.initials: D
authors.lastname: Neurath
authors.forename: Nancy
authors.initials: N
authors.lastname: Cober
authors.forename: Melanie
authors.initials: M
authors.lastname: Tokessy
authors.forename: Diane
authors.initials: D
authors.lastname: Desjardins
authors.forename: Bernhard
authors.initials: B
authors.lastname: Olberg
authors.forename: Alan
authors.initials: A
authors.lastname: Tinmouth
authors.forename: Antonio
authors.initials: A
authors.lastname: Giulivi
mesh_terms: 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
chemical_list: D000017:ABO Blood-Group System; D015415:Biomarkers; D016756:Immunoglobulins, Intravenous