Serologic problems associated with administration of intravenous immune globulin (IVIg)

Intravenous immune globulin (IVIg) is manufactured from large pools of donor plasma and contains a high diversity of antibodies, primarily IgG. For this reason, IVIg is routinely used as antibody replacement therapy for patients having primary immunodeficiencies. In 1981, IVIg was also found to be a strong immunomodulator of various inflammatory and autoimmune conditions. This observation has led to the exponential increase in the use of IVIg throughout the world, with the United States and Canada being the biggest users of IVIg. Although relatively rare, adverse events, such as hemolytic anemia and thrombosis, can complicate the administration of IVIg. More frequently, the administration of IVIg can cause serologic challenges for the transfusion service including ABO discrepancies, positive direct antiglobulin tests, positive antibody detection tests, and incompatible crossmatches. This article will review each of the potential transfusion service challenges associated with IVIg administration.