title: Intravenous immunoglobulin-induced hemolytic anemia after thoracoscopic thymectomy for myasthenia gravis.
abstract: A 24-year-old woman underwent video-assisted thoracoscopic thymectomy for Osserman IIB myasthenia gravis (MG). In preparation for thymectomy, high-dose intravenous immunoglobulin (IVIG) was administered 1 week before the surgical procedure. After uneventful thoracoscopic thymectomy, the postoperative hemoglobin value decreased from 12.1 mg/dL to 8.2 mg/dL. A diagnosis of IVIG-associated hemolytic anemia was made based on a peripheral smear with numerous spherocytes, a positive direct antiglobulin test result, and increased reticulocyte count. Hemoglobin levels after IVIG administration should be monitored closely before and after elective surgical procedures to identify severe anemia. Transfusion of type-matched blood should be avoided and risk factors understood.
authors.affiliation: Department of Surgery, Division of General Thoracic Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Tsukada
authors.affiliation: Department of Hematology and Oncology, St. Elizabeth's Medical Center, Tufts University School of Medicine Boston, Massachusetts.
authors.forename: Rajitha
authors.initials: R
authors.lastname: Sunkara
authors.affiliation: Department of Hematology and Oncology, St. Elizabeth's Medical Center, Tufts University School of Medicine Boston, Massachusetts.
authors.forename: Dorcas Doja
authors.initials: DD
authors.lastname: Chi
authors.affiliation: Department of Surgery, Division of General Thoracic Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Keogh
authors.affiliation: Department of Surgery, Division of General Thoracic Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine; Harvard Medical School, Boston, Massachusetts. Electronic address: hgaissert@partners.org.
authors.forename: Henning
authors.initials: H
authors.lastname: Gaissert
mesh_terms: D000328:Adult; D000743:Anemia, Hemolytic / Q000139:chemically induced*; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects*; D009157:Myasthenia Gravis / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted; D013934:Thymectomy
chemical_list: D016756:Immunoglobulins, Intravenous