title: The role of inflammation in intravenous immune globulin-mediated hemolysis.
abstract: Intravenous immune globulin (IVIG) therapy has shown great success in a number of autoimmune and inflammatory conditions and its use continues to increase worldwide. There is growing awareness of significant side effects of high-dose IVIG: however, particularly severe hemolysis in patients that are non-group O. It has been proposed that IVIG-associated hemolysis may be heralded by an existing inflammatory condition. In the work presented herein, we have provided a review of the pathophysiology of inflammation, particularly as it applies in immune-mediated red blood cell hemolysis, and a summary of previous publications that suggest an association between IVIG-mediated hemolysis and a state of existing inflammation. In addition, preliminary results from a prospective study to address the mechanism of IVIG-associated hemolysis are provided. These preliminary data support the idea of an existing inflammatory condition preceding overt hemolysis after high-dose IVIG therapy that: 1) is restricted to non-group O patients, 2) is seen when using IVIG doses of more than 2 g/kg, 3) involves an activated mononuclear phagocyte system, 4) may be presaged by a significant increase in the anti-inflammatory cytokine interleukin-1 receptor agonist, and 5) is independent of secretor status.
authors.affiliation: Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.
authors.forename: Jacob
authors.initials: J
authors.lastname: Pendergrast
authors.affiliation: Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.
authors.forename: Kezia
authors.initials: K
authors.lastname: Willie-Ramharack
authors.affiliation: Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.
authors.forename: Lorna
authors.initials: L
authors.lastname: Sampson
authors.affiliation: Institut Universitaire de Cardiologie et Pneumologie de Québec & CHU de Québec and Hôpitaux Enfant-Jésus et Saint-Sacrement, Quebec City, Quebec, Canada.
authors.forename: Vincent
authors.initials: V
authors.lastname: Laroche
authors.affiliation: Centre for Innovation, Canadian Blood Services, Toronto, Ontario, Canada.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Branch
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D006461:Hemolysis / Q000187:drug effects* / Q000276:immunology*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects* / Q000276:immunology / Q000627:therapeutic use; D007155:Immunologic Factors / Q000009:adverse effects* / Q000276:immunology / Q000627:therapeutic use; D007249:Inflammation / Q000139:chemically induced / Q000276:immunology / Q000473:pathology; D053590:Interleukin 1 Receptor Antagonist Protein / Q000276:immunology; D009000:Monocytes / Q000276:immunology / Q000473:pathology
chemical_list: D000017:ABO Blood-Group System; C507763:IL1RN protein, human; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D053590:Interleukin 1 Receptor Antagonist Protein