Abstract
BackgroundHemolytic anemia is a rare but reported side effect of intravenous immunoglobulin (IVIG) therapy. The risk of significant hemolysis appears greater in those patients who receive high dose IVIG. The etiology is multifactorial but may relate to the quantity of blood group antibodies administered via the IVIG product.FindingsWe describe 4 patients with significant hemolytic anemia following treatment with IVIG for Kawasaki disease (KD). Direct antibody mediated attack as one of the mechanisms for hemolysis, in this population, is supported by the demonstration of specific blood group antibodies in addition to a positive direct antiglobulin test in our patients.ConclusionsClinicians should be aware of this complication and hemoglobin should be closely monitored following high dose IVIG therapy.
Highlights
Hemolytic anemia is a rare but reported side effect of intravenous immunoglobulin (IVIG) therapy
Kawasaki disease (KD) is a systemic vasculitis in which the major complication is the development of coronary artery aneurysms (CAA)
We describe 4 patients, all from a single centre, who developed hemolytic anemia following IVIG treatment for KD
Summary
Hemolytic anemia is a rare but reported side effect of intravenous immunoglobulin (IVIG) therapy. The risk of significant hemolysis appears greater in those patients who receive high dose IVIG. Standard therapy for the treatment of KD is high dose IVIG (2 g/kg) and aspirin. IVIG is used in high doses, most frequently at 2 g/kg, as an immunomodulatory agent [2]. It is a pooled blood product acquired from thousands of blood donors and it contains measurable levels of anti-A and anti-B (IgG subclass) as well as non-ABO erythrocyte antibodies Hemolysis is a rarely reported side effect of IVIG.
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