Association of hemolysis with high dose intravenous immunoglobulin therapy in pediatric patients: An open-label prospective trial

Immunoglobulin therapy can be used to treat a wide variety of diseases. However, intravenous immunoglobin products can cause several adverse reactions, including hemolysis. The objective of this study was to determine the extent of anemia and hemolysis after high dose intravenous immunoglobin (2 g/kg) and its relationship to the ABO blood type system and hemolytic anemia blood parameters in pediatric patients.Incidence of 'Intravenous immunoglobulin related hemolysis' was %19 (6/31) after high dose intravenous immunoglobulin therapy. The blood parameters were measured before IVIG infusion (1-24 h before infusion) and 3-10 days after the first day of infusion. In terms of decrease in Hb levels; decline of <1 g/dL was detected in 25 patients (80.6%), ≥1 g/dL in 2 patients (6.5%) and >2 g/dL (severe hemolysis) in 4 patients (12.9%) after infusion. The decrease in hemoglobin, haptoglobin levels, the increase of reticulocyte count or direct bilirubin were statistically significant after infusion. Five of 6 hemolysis patients had non-O blood group, however statistically significant difference was not noted between these two groups. Also, intravenous immunoglobulin-related hemolysis was determined significantly higher in female than male patients.ConclusionMild to moderate hemolysis may be undetected after infusion and the true incidence of such reactions is difficult to document without careful clinical and laboratory follow-up. A careful risk assessment analysis should be performed before intravenous immunoglobulin infusion.