Positive antiglobulin tests due to intravenous immunoglobulin in patients who received bone marrow transplant

Abstract

To investigate an increased frequency of positive direct (DAT) and indirect (IAT) antiglobulin tests in bone marrow transplant (BMT) patients who received intravenous immunoglobulin (IVIG), serologic testing was performed weekly on blood samples from 94 consecutive BMT patients. Group 1 (47 patients) did not receive IVIG. Group II (47 patients) received high-dose IVIG as prophylaxis for cytomegalovirus infections. Before transplantation no alloantibodies were found in the serums of 92 patients and anti-E was found in the serums of two patients. DATs were negative in all patients before BMT. Four percent of Group I had a positive IAT and 13 percent had a positive DAT. In contrast, 25.5 percent of Group II patients had a positive IAT and 49 percent had a positive DAT, usually within 1 week after initiation of IVIG therapy (p less than 0.001). Antibodies identified in serums and eluates of patients in Group I were anti-A and anti-B. Antibodies identified in serums and eluates of patients in Group II were anti-A, -B, -D, and -K. Twenty-one lots of IVIG were tested and antibodies identified were anti-A, -B, -D, and -K. The data suggest that the higher frequency of positive serologic tests in Group II was due to passively acquired antibodies from high-dose IVIG.

Intravascular Hemolytic Anemia in a Patient with Antibodies Related to Meropenem

“…The initial detection of panagglutinin suggested a warm-type autoimmune process; however, the eluate was nonreactive. Obtaining a careful clinical history, including medications and their temporal relationship with the onset of hemolysis, is critical because positive DAT findings with a negative eluate are commonly associated with DIIHA, the passive transfer of ABO antibodies (10), such as anti-A or anti-B, due to prior out-of-group plasma or platelet transfusion (11), intravenous immunoglobulin therapy (12) or hemolytic disease of the newborn or fetus (13). In this case, we reviewed the patient's medication profile and recent transfusions, although the possibility of DIIHA could not be ruled out; thus, meropenem was discontinued and a further work-up was initiated.…”

Lyme Myocarditis Presenting as Chest Pain in an Adolescent Girl

“…Echocardiography is abnormal in up to 98% of cases and typically reveals segmental wall motion abnormalities. [10][11][12] When possible, clinicians should attempt to send immunoglobulin-based diagnostic assays before IVIG administration. 2,4 Aspartate aminotransferase elevation and cardiac troponin T greater than 0.052 ng/mL are also strongly associated with pediatric myocarditis.…”

Immunoglobulin Therapy

“…[71][72][73] Clinically significant hemolysis is very rare in licensing studies of IVIG for primary immune deficiency, using doses of 400-800 mg/kg. In non-O blood type recipients, anti-A and anti-B antibodies from the IVIG may react with red blood cells to cause asymptomatic Coombs positivity, or less commonly clinically significant hemolytic reactions, especially in those receiving high cumulative doses of immune globulin.…”