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Intravenous Immunoglobulin-induced Hemolysis - Video

Published On 2022-10-28T10:00:04+05:30  |  Updated On 29 Oct 2022 2:37 PM IST
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Overview

It is known that intravenous immunoglobulin is an established treatment for many immune-mediated disorders.

A study Shows about presents case report of two individuals highlighting a potentially serious but under-recognized side effect of Intravenous immunoglobulin therapy.

A 67-year-old female, with no pertinent past medical history, presented with a 3-day history of acute onset progressive quadriparesis with intact bladder-bowel functions. Global areflexia on neurological examination with intact sensations along with nerve conduction studies (NCS) suggestive of motor, demyelinating polyneuropathy and albuminocytological dissociation in cerebrospinal fluid (CSF) examination led to the diagnosis of Guillain-Barré syndrome.

Doctors administered Intravenous immunoglobulin for 5 days. She received 170 gm of Intravenous immunoglobulin. Although her limb weakness stabilized, she developed acutely progressive anemia on day 9 of starting IVIG and her hemoglobin dropped to 8 gm/dL a day later.

Peripheral smear revealed 2–3 nucleated red blood cells (RBCs)/100 white blood cells and abundant polychromatophils. Her direct antiglobulin test (DAT) was negative on two occasions. She was transfused with one unit of packed O red blood cells. Her hemoglobin improved to 11.2 gm/dL and her reticulocyte count dropped to 2% on day 24 after Intravenous immunoglobulin initiation.

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

Speakers

Dr. Nandita Mohan

Dr. Nandita Mohan is a practicing pediatric dentist with more than 5 years of clinical work experience. Along with this, she is equally interested in keeping herself up to date about the latest developments in the field of medicine and dentistry which is the driving force for her to be in association with Medical Dialogues. She also has her name attached with many publications; both national and international. She has pursued her BDS from Rajiv Gandhi University of Health Sciences, Bangalore and later went to enter her dream specialty (MDS) in the Department of Pedodontics and Preventive Dentistry from Pt. B.D. Sharma University of Health Sciences. Through all the years of experience, her core interest in learning something new has never stopped. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751
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