Intravenous Immunoglobulin Administration Induces Severe Anemia and Cross-Matching Incompatibility in Neonates

This study aimed to explore the severe anemia and cross-matching incompatibility caused by intravenous immunoglobulin (IVIG) administration and the selection of accurate red blood cells (RBC) for transfusion.

Cross-matching, direct antiglobulin test (DAT), free antibody test (FAT), and elution test (ET) were performed with the neonatal samples before and after IVIG administration simultaneously. The blood samples after IVIG administration were performed by cross-matching with antihuman globulin (AHG) microcolumn gel card (AHG-card) and AHG tube method (AHG-tube) with the same packed RBC suspension simultaneously. The laboratory results before and after IVIG administration and after packed RBC suspension transfusion were collected. The incidence of RBC transfusion adverse reactions was collected as well.

Out of 30 neonates enrolled in this study, the indication of IVIG was sepsis in 18, necrotizing enterocolitis (NEC) in 10, and undetermined reason in 2. The IVIG administration ranges of dose, frequency, and dose/weight were 1.8 - 7.5 g, 1 - 3 times, and 0.8 - 2.9 g/kg. Cross-matching tests by AHG-card, DAT, FAT, and ET were all positive in 30 neonates after administration of IVIG, the elevation of lactic dehydrogenase (LDH) and unconjugated bilirubin and reduction of RBC and HGB were statistically significant after IVIG administration. The incompatibility cases of AHG-card and AHG-tube were 30 and 6, respectively. Compared with laboratory test results before IVIG administration, after packed RBC suspension transfusion, the RBC and HGB of 30 neonates increased significantly. No RBC transfusion adverse reaction was observed.

IVIG administration can lead to severe anemia and cross-matching incompatibility using AGH-card. Safe and cautious IVIG administration is necessary for neonates. AGH-tube can be a solution for cross-matching incompatibility using AGH-card.