Intravenous immunoglobulin‐induced haemolysis: a case report and review of the literature

Desborough, Michael; Miller, Joanne; Thorpe, Susan J.; Mj, Murphy; Misbah, Siraj

doi:10.1111/tme.12083

Cited by 49 publications

(75 citation statements)

References 34 publications

(38 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In one study, six of nine babies required treatment due to anti‐A,B hemolytic disease of the fetus and newborn, whereas in babies having only anti‐A or anti‐B on their RBCs, only five of 14 required treatment . Although the contribution of anti‐A,B to hemolysis after administration of IVIG to either group A or group B individuals has not been addressed, a significant number of ABO‐associated hemolysis cases have been reported after IVIG administration and can be severe …”

Section: Abo Isohemagglutinins: Relevance To Intravenous Immunoglobulinmentioning

confidence: 99%

Anti‐A and anti‐B: what are they and where do they come from?

Branch

2015

Transfusion

View full text Add to dashboard Cite

Intravenous immunoglobulin (IVIG) is made from thousands of donors having a variety of blood groups. All of the donors being used for IVIG production, with the exception of group AB donors, have in their plasma antibodies of variable titer commonly known as isohemagglutinins or ABO antibodies. As blood groups O and A are the most commonly found in the world population, most of the plasma used in IVIG production is from donors having these blood groups, with group B and group AB donors being fewer in number. Consequently, all batches of IVIG contain antibodies that are reactive with individuals of group A, group B, and group AB. These antibodies were originally discovered by Dr Karl Landsteiner in the early 1900s and are now known to consist of immunoglobulin (Ig)M, IgG, and IgA classes. As the process for producing IVIG results in almost exclusively IgG, isohemagglutinins contained in IVIG are of this immunoglobulin class. ABO antibodies are highly clinically significant and, because of this, blood bank cross-matching is done to ensure that blood of the correct type is transfused into recipients to avoid a so-called major mismatch or major incompatibility that can cause significant morbidity and often death. Administration of IVIG, which contains ABO antibodies, is often infused into individuals who have the corresponding ABO antigens, commonly called a minor mismatch, and although not as significant as a major mismatch, the isohemagglutinins contained in the IVIG have some risk for a significant transfusion reaction due to the ABO incompatibility. Indeed, currently there is no way to match IVIG to recipients according to blood type, so when IVIG is administered to group A, B, or AB recipients, there is potential for transfusion reactions analogous to a blood transfusion mismatch. For this reason, strict guidelines have been put into place to restrict the titers of the ABO antibodies contained in IVIG. This review will provide background information about the discovery and biochemistry of the ABO antigens and discuss the various isohemagglutinins that are found in plasma of the different ABO blood types and their potential clinical significance. In addition, a brief discussion of the controversial topic of the origins of these antibodies will conclude this review.

show abstract

Section: Abo Isohemagglutinins: Relevance To Intravenous Immunoglobulinmentioning

confidence: 99%

Anti‐A and anti‐B: what are they and where do they come from?

Branch

2015

Transfusion

View full text Add to dashboard Cite

show abstract

“…The IV administration of immunoglobulins has long been noted to sometimes be associated with a positive direct antiglobulin test (DAT) and a mild decrease in hemoglobin (Hb) . More than 900 suspected cases of IVIG‐associated hemolysis have been reported to hemovigilance groups; however, not all of these cases are confirmed . The hemolysis is usually self‐limited with rapid resolution, but may be of significant clinical concern with occasional patients requiring red blood cell (RBC) transfusion .…”

mentioning

confidence: 99%

Possible mechanisms for intravenous immunoglobulin–associated hemolysis: clues obtained from review of clinical case reports

Padmore

2015

Transfusion

View full text Add to dashboard Cite

It is known that high-dose IVIG given to non-O blood group patients with underlying inflammatory and/or immune-mediated disorders is associated with increased risk of hemolysis. This review reveals additional patient characteristics in cases of IVIG-associated hemolysis, including underrepresentation of D- and group B cases, higher incidence in pediatric Kawasaki disease and unique at-risk patient groups including allogeneic stem cell transplant recipients with group A donor in a group O recipient, and patients in whom soluble AB substance is removed by plasma exchange at the same time as receiving IVIG.

show abstract

“…Furthermore, it may be necessary to implement closer monitoring of patients receiving IVIG (14). Finally, given the recent publication demonstrating lower ABO antibody levels in Cytogam and equivalently prepared IVIG preparations, these products may be more appropriate for use in the ABOi transplant population if antibody titers will be used for patient monitoring (13,19,20).…”

Section: Discussionmentioning

confidence: 99%

“…Although it is known that IVIG contains ABO antibodies at concentrations that vary among manufacturers and by lot number, there is limited information in the transplantation literature regarding the effects of IVIG preparations on antibody titers or even on which preparations of IVIG are in use at different facilities (10)(11)(12)(13). The presence of ABO antibodies in IVIG is commonly thought of in the context of hemolysis risk in non-group O patients being treated with IVIG (14). In this report, we describe an ABO-incompatible (ABOi) renal transplant recipient for whom postsurgical IVIG administration led to increased anti-A titers, complicating posttransplant management.…”

Section: Introductionmentioning

confidence: 99%