Hemolytic transfusion reactions after administration of intravenous immune (gamma) globulin: a case series analysis

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Abstract
BACKGROUND: This case series summarizes our observations of hemolytic reactions after the administration of large amounts of intravenous immune (gamma) globulin (IVIG).STUDY DESIGN AND METHODS: Cases of hemolysis were identified by a decrease in hemoglobin not otherwise explained following IVIG administration.RESULTS: Sixteen cases were identified over a 2½‐year period at the Ottawa Hospital of approximately 1000 patients receiving IVIG (1.6%). Characteristics of these patients include a large dose of IVIG, female sex, non‐O blood group, and underlying inflammatory state.CONCLUSIONS: Significant hemolysis may occur after the administration of large doses of IVIG. A two‐step mechanism of hemolysis is proposed, sensitization by ABO isohemagglutinins followed by phagocytosis by activated macrophages. A simple protocol to facilitate the early detection of such cases is presented.

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