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This Article Full Text Full Text (PDF) All Versions of this Article: CJN.04540709v1 4/12/1993    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kahwaji, J. Articles by Vo, A. A. Search for Related Content PubMed PubMed Citation Articles by Kahwaji, J. Articles by Vo, A. A.

Acute Hemolysis After High-Dose Intravenous Immunoglobulin Therapy in Highly HLA Sensitized Patients

Joseph Kahwaji^*, Eva Barker, Sam Pepkowitz, Ellen Klapper, Rafael Villicana^*, Alice Peng^*, Robert Chang^*, Stanley C. Jordan^*, and Ashley A. Vo^*

^* Comprehensive Transplant Center, Department of Pharmacy, and Department of Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California

Correspondence: Dr. Joseph Kahwaji,Comprehensive Transplant Center, Cedars-Sinai Medical Center. 8635 W. 3rd Street, Suite 490, West Los Angeles, CA 90048. Phone: 310-423-3069; Fax: 310-423-0234; E-mail: Kahwajij{at}cshs.org

Background and objectives: Intravenous Ig (IVIG) is used in renal transplantation for desensitization and treatment of antibody-mediated rejection (AMR). The infusion of high-dose IVIG is generally well tolerated, but there are reports of hemolytic anemia induced by anti-blood group antibodies present in IVIG. Here, we report our experience with IVIG-induced hemolytic anemia (IH) in ESRD patients receiving IVIG for desensitization or treatment of AMR.

Design, setting, participants, & measurements: All patients receiving IVIG for desensitization or for treatment of AMR were monitored for evidence of acute anemia and hemolysis. Markers of hemolysis, including direct antiglobulin tests, were recorded. Five different IVIG products were tested for isohemagglutinin titers.

Results: There were 18 cases of IH in 16 patients. All identified cases received the IVIG product Gamunex, Gammagard liquid, or Privigen. All patients developing hemolysis were non-O blood types. Isohemagglutinin titers ranged from 1:2 to 1:64 in the various IVIG products, with higher titers noted in the liquid, nonlyophilized products.

Conclusions: Acute IH is a significant complication of high-dose IVIG infusion. Identified risk factors include non-O blood type of the recipient and administration of liquid IVIG preparations with high titer anti-A/B IgG antibodies. We recommend monitoring hemoglobin 48 to 72 h after IVIG infusion. If the hemoglobin decreases, a hemolytic work-up is recommended. Hemolysis could be avoided in at risk patients by choosing a low titer product. However, other complications such as acute renal failure or thrombosis may be seen because the low titer products are usually hyperosmotic.