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Hemolytic transfusion reactions after administration of intravenous immune (gamma) globulin: a case series analysis
Zohra Daw1, Ruth Padmore, Doris Neurath
1Division of Hematology and Transfusion Medicine, Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.
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 2 1/2-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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