title: Occurrence of hemolytic anemia in patients with GBS treated with high-dose IVIg.
abstract: OBJECTIVE
  We describe an underrecognized side effect of high-dose IV immunoglobulin (IVIg), hemolytic anemia.
  
  
  BACKGROUND
  There are no established guidelines on treating patients with Guillain-Barré syndrome (GBS) who relapse or do not improve after a standard course of treatment (IVIg or plasma exchange). Some centers will opt for a second course of the initial treatment. There is an ongoing trial of a second course of IVIg in patients with severe GBS.
  
  
  METHODS
  We retrospectively reviewed 4 patients with severe GBS who received high-dose IVIg. One patient inadvertently received a high dose of IVIg for Miller Fisher syndrome. All patients received a total of at least 2 courses of the standard dose of IVIg (total >4 g/kg). We review their clinical course and side effects.
  
  
  RESULTS
  All patients with non-O blood types developed clinically significant hemolytic anemia requiring blood transfusion.
  
  
  CONCLUSIONS
  Hemolytic anemia may limit doses of IVIg for treatment of severe GBS in patients with non-O blood types.
authors.affiliation: Departments of Neurology (T.P.N., S.B., K.S.) and Pathology (A.W.), University of Texas Health Science Center at Houston, TX.
authors.forename: Thy P
authors.initials: TP
authors.lastname: Nguyen
authors.affiliation: Departments of Neurology (T.P.N., S.B., K.S.) and Pathology (A.W.), University of Texas Health Science Center at Houston, TX.
authors.forename: Suur
authors.initials: S
authors.lastname: Biliciler
authors.affiliation: Departments of Neurology (T.P.N., S.B., K.S.) and Pathology (A.W.), University of Texas Health Science Center at Houston, TX.
authors.forename: Amer
authors.initials: A
authors.lastname: Wahed
authors.affiliation: Departments of Neurology (T.P.N., S.B., K.S.) and Pathology (A.W.), University of Texas Health Science Center at Houston, TX.
authors.forename: Kazim
authors.initials: K
authors.lastname: Sheikh