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. 2008 Aug;48(8):1598-601.
doi: 10.1111/j.1537-2995.2008.01721.x. Epub 2008 May 2.

Hemolytic transfusion reactions after administration of intravenous immune (gamma) globulin: a case series analysis

Zohra Daw  1 , Ruth Padmore, Doris Neurath, Nancy Cober, Melanie Tokessy, Diane Desjardins, Bernhard Olberg, Alan Tinmouth, Antonio Giulivi
Affiliations

Hemolytic transfusion reactions after administration of intravenous immune (gamma) globulin: a case series analysis

Zohra Daw et al. Transfusion. 2008 Aug.

Abstract

Background: This case series summarizes our observations of hemolytic reactions after the administration of large amounts of intravenous immune (gamma) globulin (IVIG).

Study design and methods: Cases of hemolysis were identified by a decrease in hemoglobin not otherwise explained following IVIG administration.

Results: Sixteen cases were identified over a 2 1/2-year period at the Ottawa Hospital of approximately 1000 patients receiving IVIG (1.6%). Characteristics of these patients include a large dose of IVIG, female sex, non-O blood group, and underlying inflammatory state.

Conclusions: Significant hemolysis may occur after the administration of large doses of IVIG. A two-step mechanism of hemolysis is proposed, sensitization by ABO isohemagglutinins followed by phagocytosis by activated macrophages. A simple protocol to facilitate the early detection of such cases is presented.

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