HEMOLYTIC TRANSFUSION REACTION (HTR) ASSOCIATED WITH INTRAVENOUS IMMUNE GLOBULIN (IV Ig)

Abstract

High dose IV Ig has been tried in immune cytopenia(s) with few complications. We report a severe HTR due to IV Ig. A 10 yr-old B Rho(D) pos. boy who received a bone marrow transplant (BMT) from his O Rho(D) neg. sister was given IV Ig (C51911, GAMIMUNE, 5%, Cutter Lab.) for platelet alloimmunization. On day 9 post-BMT he developed a chill and hypotension after 120 ml of IV Ig and hemoglobinuria later. On day 10 he had a severe shaking chill after 100 ml of IV Ig and symptoms recurred after 2 ml of infusion. On days 10 to 12 he had hyperbilirubinemia (4.5 mg/dl), hemoglobinemia (98 mg/dl), hemoglobinuria (75 mg/dl) and no haptoglobin. Hb remained between 6-7 g/dl with 8 units of RBC. On day 13 urine became clear and Hb rose without transfusions (Tx). No Tx were given 48 hrs. pre-IV Ig. After BMT he was given O neg. deglycerolized-RBC and group B plasma and platelets. Pre-IV Ig he was B pos. and had a negative direct antiglobulin test (AGT) and antibody screen. Post-IV Ig direct and indirect AGT were positive (days 10-13); anti-B (1:4) was detected in his sera from day 12. Sera and eluate demonstrated antiglobulin reactivity with group B RBC. The IV Ig he received had 1:64 for anti-B and Anti-A. On day 16, patient was typed as O neg. without reticulocytosis, indicating massive intravascular hemolysis of autologous RBC, not a response to BMT. Since blood group antibodies are present in human immune serum globulin preparations, compatibility test should be done when using IV Ig to prevent HTR.