Thromboembolic events as an emerging adverse effect during high-dose intravenous immunoglobulin therapy in elderly patients: a case report and discussion of the relevant literature

Abstract

A case of an 82-year-old man who suffered an acute ST-elevation myocardial infarction while receiving treatment with intravenous immunoglobulin (IVIg) for thrombocytopenia is discussed. A total of 29 other cases of thromboembolism related to IVIg therapy have been reported, and the incidence seems to be especially high in elderly patients with cerebrovascular risk factors and also in patients with paraproteinemias. Possible mechanisms to account for this complication may include some of the following: platelet activation, increased blood viscosity, contamination of IVIg with activated coagulation factors, induced arterial vasospasm, production of vasoconstrictive cytokines, and vasculitis. Ten patients out of the 29 reported patients died from this serious complication. In our patient, spontaneous reperfusion occurred without any treatment and he had an uneventful outcome.

Use of intravenous immunoglobulin in human disease: A review of evidence by members of the Primary Immunodeficiency Committee of the American Academy of Allergy, Asthma and Immunology

“…1 Furthermore, the administration of IGIV can lead to numerous side effects and potential additional adverse consequences. [2][3][4][5][6] Despite this, the appropriate use of immunoglobulin can be life-saving.…”

Hematologic toxicities associated with intravenous immunoglobulin therapy

“…Thrombosis is a serious complication of IVIG administration and has been reported in the form of stroke, pulmonary embolism (PE), deep vein thrombosis (DVT), and arterial thrombotic events including myocardial infarction (MI) and stroke (Table 5) [10][11][12][13][14][15][16][17][18][19][20][21]. Orbach and Katz also previously published extensive overviews of thromboembolic events reported following IVIG administration [11,22].…”

“…Various mechanisms of IVIG's influence on thrombotic complications have been described in the literature, the most common being a dosedependent increase in plasma viscosity [10,11,14,16,17]. In vivo tests demonstrated an increase in plasma viscosity and erythrocyte aggregation after IVIG administration [25].…”

Effect of Immunoglobulin Therapy on Blood Viscosity and potential concerns of Thromboembolism, Especially in Patients with Acute Kawasaki Disease

“…Various adverse reactions have been reported in association with the therapy: anaphylactic reactions, aseptic meningitis, acute renal failure, headaches fatigue, chills, backache leg cramps, lightheadedness, fever, urticaria, flushing, elevation of blood pressure, nausea and vomiting, and local pain and irritation at the infusion site [22]. Also, the risk of contamination with HIV, HBV, HCV or other microbial agents cannot be completely negated [23].…”