Iatrogenic Central Retinal Vein Occlusion and Hyperviscosity Associated with High-dose Intravenous Immunoglobulin Administration

Strokes after intravenous gamma globulin: Thrombotic phenomenon in patients with risk factors or just coincidence?

“…Great concern regarding the safety of IVIG products was raised after several cases of strokes, myocardial infarctions, and acute peripheral vascular events were reported to occur within 10 days of immunoglobulin administration [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. Although the pathogenesis of such events is not completely understood, several mechanisms have been proposed but have not been proven to cause thrombosis.…”

“…Aseptic meningitis with a self-limiting course [4] and severe headaches [5] may also occur, while transient encephalopathy was observed in 3 published cases [6][7][8]. More recently, cases of acute myocardial infarctions [9][10][11][12][13] and thrombotic events, some fatal [14][15][16][17][18][19], have also been observed. Moreover, cases of strokes following immunoglobulin infusion have been reported, with a higher incidence in the elderly [20][21][22][23][24][25].…”

Single High-Dose Intravenous Immunoglobulin Therapy for Kawasaki Disease Increases Plasma Viscosity

“…4 However, IVIg therapy especially for elderly patients who have concomitant atherosclerosis is occasionally associated with serious thromboembolism such as myocardial infarction, [5][6][7] pulmonary thromboembolism, 8 stroke, [7][8][9][10][11] and venous thrombosis. [12][13][14][15] Although several mechanisms are proposed to explain the prothrombotic effects of IVIg, 11 the major cause is considered to be an increase in blood viscosity. 16 A report by Nishikawa et al shows that IVIg therapy for KD did not increase whole blood viscosity.…”

Retinal vein occlusion following intravenous immunoglobulin treatment

“…Five cases of stroke, two cases of deep vein thrombosis, seven myocardial infarctions, one case each of RVO and pulmonary embolism have so far been described with IVIg [1][2][3][4][5][6][7]. The rate of thrombotic complications following IVIg may be as high as 3-5% though underreported and can involve both arterial and venous circulation [8].…”

“…These viscous effects are dose dependent and can last for weeks, increasing susceptibility to thromboembolism [9,10]. Across the world, irrespective of brands IVIg related thrombotic complications have been reported, generally occurring between 1-14 days of the therapy [4,5]. …”