Intravenous Immunoglobulin-induced Hemolysis

The second report was of a 28-year-old male, with no significant past medical history, presented with a 4-day history of acute onset progressive motor quadriparesis without bladder-bowel involvement. Neurological examination revealed global areflexia and intact sensations. Motor demyelinating polyneuropathy in nerve conduction studies and albuminocytological dissociation in Cerebro Spinal Fluid examination favored the diagnosis of Guillain-Barré syndrome. The team infused a total Intravenous immunoglobulin dose of 140 gm over 5 days. He developed acute onset anemia with a rapid drop in hemoglobin level to 7.7 gm/dL on day 10 of initiating Intravenous immunoglobulin.

Rise in indirect bilirubin and serum LDH along with peripheral smear showing nucleated RBCs and polychormasia, favored hemolysis. Thereafter, his hemoglobin improved to 11.8 gm/dL on day 24 after Intravenous immunoglobulin initiation.

So keeping these 2 reports in mind, researchers concluded that these case studies highlight a potentially serious but under-recognized side effect of Intravenous immunoglobulin therapy. It is important that medical practitioners are aware of this adverse effect for early recognition and management.

Reference:

Divya M Radhakrishnan1, Niraj Kumar2, Ishita Desai3, Ashutosh Tiwari4, Mritunjai Kumar5, Sheetal Malhotra6, Gita Negi; Intravenous Immunoglobulin-induced Hemolysis, JAPI 2022