title: Hemolysis in patients with antibody deficiencies on immunoglobulin replacement treatment.
abstract: BACKGROUND
  Immunoglobulin (Ig)G replacement with intravenous or subcutaneous immunoglobulins is a lifelong substitutive therapy in patients with primary antibody deficiencies (PADs). Hemolysis after immunoglobulin therapy was described in patients receiving high immunoglobulin dosages. The issue of hemolysis after immunoglobulin administration at replacement doses has been considered of little clinical significance.
  
  
  METHODS
  This was a single-center observational study over a 2-year period on immunoglobulin-induced hemolysis in a cohort of 162 patients with PADs treated with immunoglobulin administered at replacement dosages.
  
  
  RESULTS
  Six patients had signs and symptoms of immunoglobulin-induced hemolysis. Two additional asymptomatic patients were identified by a short-term study run on 16 randomly selected asymptomatic patients. Alloantibodies eluted from patients' red blood cells (RBCs) had anti-A and Rh specificities (anti-D and anti-C). The immunoglobulins contained alloantibodies with the same specificities of the antibodies eluted from patients' RBCs.
  
  
  CONCLUSIONS
  Hemolysis occurred in patients receiving immunoglobulin at replacement dosages. Polyvalent immunoglobulin preparations contained multiple clinically significant antibodies that could have unexpected hemolytic consequences, as anti-C whose research and titration are not required by the European Pharmacopoeia. The issue of hemolysis in long-term recipients of immunoglobulin treatment administered at replacement dosages should be more widely recognized.
authors.affiliation: Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.
authors.forename: Isabella
authors.initials: I
authors.lastname: Quinti
authors.affiliation: Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Pulvirenti
authors.affiliation: Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Milito
authors.affiliation: Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Granata
authors.affiliation: Unit of Immunohematology and Transfusion Medicine, Sapienza University of Rome, Rome, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Giovannetti
authors.affiliation: Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.
authors.forename: Fabiola
authors.initials: F
authors.lastname: La Marra
authors.affiliation: Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Pesce
authors.affiliation: Plasma Protein Therapeutics Association, Annapolis, Maryland.|School of Surgery, University of Western Australia, Crawley, Western Australia, Australia.|School of Medicine, Australian National University, Canberra, Australia.
authors.forename: Albert
authors.initials: A
authors.lastname: Farrugia
authors.affiliation: Unit of Immunohematology and Transfusion Medicine, Sapienza University of Rome, Rome, Italy.
authors.forename: Serelina
authors.initials: S
authors.lastname: Coluzzi
authors.affiliation: Unit of Immunohematology and Transfusion Medicine, Sapienza University of Rome, Rome, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Girelli
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004912:Erythrocytes / Q000502:physiology; D005260:Female; D006461:Hemolysis / Q000502:physiology; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D008297:Male; D064887:Observational Studies as Topic; D055815:Young Adult
chemical_list: D007074:Immunoglobulin G