Haemolysis induced by intravenously-administered immunoglobulin

Area of Science:

• Immunology
• Hematology

Background:

• Intravenous gamma-globulin (IVIG) is a critical therapy derived from pooled human plasma.
• IVIG preparations contain various antibodies, including alloantibodies, which can pose risks if not managed.
• Hemolytic reactions are a known, albeit rare, complication of IVIG therapy.

Observation:

• Two patients experienced concurrent hemolytic reactions following IVIG administration.
• These reactions were primarily attributed to passively acquired anti-A antibodies.
• Anti-D antibodies were also implicated in one patient's first hemolytic episode and the second patient's episode.

Findings:

• The observed hemolysis was linked to the presence of specific alloantibodies (anti-A and anti-D) in the IVIG batches.
• The reactions could have been prevented by performing a minor crossmatch test prior to IVIG infusion.
• Both patients' reactions were associated with passively transferred antibodies from the IVIG product.

Implications:

• Implementing pre-transfusion minor crossmatch procedures for IVIG therapy is crucial for patient safety.
• Manufacturers should establish safe alloantibody titers for IVIG preparations.
• Standardizing the volume of IVIG batches to facilitate pre-administration crossmatching is recommended.