Abstract
Objective:We describe an underrecognized side effect of high-dose IV immunoglobulin (IVIg), hemolytic anemia.Background:There are no established guidelines on treating patients with Guillain-Barré syndrome (GBS) who relapse or do not improve after a standard course of treatment (IVIg or plasma exchange). Some centers will opt for a second course of the initial treatment. There is an ongoing trial of a second course of IVIg in patients with severe GBS.Methods:We retrospectively reviewed 4 patients with severe GBS who received high-dose IVIg. One patient inadvertently received a high dose of IVIg for Miller Fisher syndrome. All patients received a total of at least 2 courses of the standard dose of IVIg (total >4 g/kg). We review their clinical course and side effects.Results:All patients with non-O blood types developed clinically significant hemolytic anemia requiring blood transfusion.Conclusion:Hemolytic anemia may limit doses of IVIg for treatment of severe GBS in patients with non-O blood types.
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