title: Intravenous immune globulin therapy for Stevens-Johnson syndrome/toxic epidermal necrolysis complicated by hemolysis leading to pigment nephropathy and hemodialysis.
abstract: BACKGROUND
  Intravenous immune globulin (IVIG) is generally thought to be of relatively low risk for adverse events and some experts consider this to be the best treatment for Stevens-Johnson syndrome/toxic epidermal necrolysis.
  
  
  OBJECTIVE
  We evaluated the underlying cause of anemia and renal failure in 2 consecutive patients being treated with IVIG for Stevens-Johnson syndrome/toxic epidermal necrolysis.
  
  
  METHODS
  This is a retrospective chart review.
  
  
  RESULTS
  We present 2 patients with Stevens-Johnson syndrome/toxic epidermal necrolysis and severe hemolysis requiring blood transfusion who subsequently developed pigment nephropathy necessitating hemodialysis after treatment with IVIG. Both patients had antibodies to their ABO blood type detected in the eluate from their red blood cell membrane.
  
  
  CONCLUSIONS
  This is a retrospective review with only 2 cases.
  
  
  CONCLUSIONS
  We propose that IVIG-associated hemolysis is an adverse reaction that may not be as rare as once thought, presenting as a mild decrease in hemoglobin and hematocrit. Antibodies to blood type A and B are given as part of pooled immune globulin and are considered to be the cause of hemolysis. More severe anemia requiring transfusion is less common, and the breakdown products produced by hemolysis can lead to pigment nephropathy and renal failure. We present methods by which this severe complication can be anticipated and managed more effectively.
authors.affiliation: Department of Dermatology, University of Utah, Salt Lake City, Utah 84132-2409, USA. Marnie.Ririe@hsc.utah.edu
authors.forename: Marnie R
authors.initials: MR
authors.lastname: Ririe
authors.forename: Robert C
authors.initials: RC
authors.lastname: Blaylock
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Morris
authors.forename: Jae Y
authors.initials: JY
authors.lastname: Jung
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000628:therapy; D001803:Blood Transfusion; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005500:Follow-Up Studies; D006461:Hemolysis / Q000187:drug effects*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013262:Stevens-Johnson Syndrome / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous
keywords: DAT; IVIG; SJS; Stevens-Johnson syndrome; TEN; adverse medication reaction; direct antiglobulin test; hemodialysis; hemolysis; intravenous immune globulin; pigment nephropathy; toxic epidermal necrolysis; transfusion