Intravenous immunoglobulin anemia

A 33-year-old woman with Evans syndrome received intravenous immunoglobulin 400 mg/kg/day and developed a deep vein thrombosis after 1 week (47). She was treated with warfarin, and 6 months later received an additional course of intravenous immunoglobulin for recurrent hemolytic anemia 1 day later she died of pulmonary thromboembolism. 

Severe acute hemolysis due to acquisition of red cell alloantibodies from donor serum has been reported (67-69). In other cases, the suggested mechanism of hemolytic anemia after high dosages of intravenous immunoglobulin was the presence of anti-A and/or anti-B antibodies in the plasma product (70). 

Nakagawa M, Watanabe N, Okuno M, Kondo M, Okagawa H, Taga T. Severe hemolytic anemia following high-dose intravenous immunoglobulin administration in a patient with Kawasaki disease. Am J Hematol 2000 63(3) 160-1. 

A 26-year-old woman with a diffuse large B cell lymphoma received CHOP (cyclophosphamide, hydroxy-daunomycin, Oncovin, and prednisone), ritnximab, and radiotherapy (14). She developed a transfnsion-dependent anemia. Bone marrow biopsy confirmed pure red cell aplasia and parvovirus infection. She had no antibodies to parvovirus, suggesting that she never had a previous exposure. Intravenous immunoglobulin resulted in a reticulocytosis and recovery of her hemoglobin. 

Anti-D immunoglobulin is used as an alternative to intravenous immunoglobulin to treat idiopathic thrombocytopenic purpura. Patients treated with anti-D immunoglobulin (WinRho ), in contrast to earlier published reports, had more adverse reactions, particularly chills and rigors, despite pretreatment with paracetamol and diphenhydramine [66 ]. Two patients needed treatment for severe anemia and one for severe hemoglobinuria. Pretreatment with glucocorticoids or the use of subcutaneous anti-D immunoglobulin may reduce transfusion-related adverse reactions. However, the... 

In 46 patients with primary immunodeficiency treated with intravenous immunoglobulin 10%, no subject converted for hepatitis A, B or C, HIV, or parvovirus B19 [44 ]. In a subgroup of the 1MPACT2 trial, none of the 16 patients treated with plasma-derived Cl -inhibitor concentrate seroconverted for HIV, hepatitis viruses, or parvovirus B19. This report adds to the almost 40 years of experience with treatment of attacks of hereditary angioedema with plasma-derived Cl -INH, in which no detectable viral transmission occurred [26 j. Probable clinically asymptomatic parvovirus B19 seroconversion was reported in 3 of 20 patients after administration of prothrombin complex concentrate [32 ]. Hepatitis-associated aplastic anemia may be... 

Yin F, Nesbitt JA, Tobian AA, Holt PA, Mikdashi J. Hemolytic anemia following intravenous immunoglobulin administration. Am J Hematol 2008 83(10) 825. 

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