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- Title
Hemolysis related to intravenous immunoglobulins is dependent on the presence of anti-blood group A and B antibodies and individual susceptibility.
- Authors
Mielke, Orell; Fontana, Stefano; Goranova‐Marinova, Vesselina; Shebl, Amgad; Spycher, Martin O.; Wymann, Sandra; Durn, Billie L.; Lawo, John P.; Hubsch, Alphonse; Salama, Abdulgabar
- Abstract
<bold>Background: </bold>Patients treated with intravenous immunoglobulins (IVIG) rarely experience symptomatic hemolysis. Although anti-A and anti-B isoagglutinins from the product are involved in most cases, the actual mechanisms triggering hemolysis are unclear.<bold>Study Design and Methods: </bold>A prospective, open-label, multicenter, single-arm clinical trial in 57 patients with immune thrombocytopenia treated with IVIG (Privigen, CSL Behring) was conducted.<bold>Results: </bold>Twenty-one patients received one infusion (1 g/kg) and 36 received two infusions (2 × 1 g/kg) of IVIG. After a study duration of more than 2 years, no cases of clinically significant hemolysis as defined in the protocol were identified. Data of patients with mild hematologic and biochemical changes were analyzed in more detail. Twelve cases (10/23 patients with blood group A1 and 2/11 patients with blood group B, all having received 2 g/kg IVIG) were adjudicated as mild hemolysis (median hemoglobin [Hb] decrease, -3.0 g/dL); Hb decreases were transient, with partial or full recovery achieved by last visit. Eighteen patients (31.6%), all with non-O blood group, of whom 16 (88.9%) received 2 g/kg IVIG, fulfilled post hoc criteria for hemolytic laboratory reactions. Red blood cell (RBC) eluates of all direct antiglobulin test-positive samples were negative for non-ABO blood group antibodies. Blood groups A and B antigen density on RBCs appeared to be a risk factor for hemolytic laboratory reactions. Platelet response to treatment was observed in 42 patients (74%); eight of 12 patients with complete response had blood group A1.<bold>Conclusion: </bold>Isoagglutinins are involved in clinically nonsignificant hemolysis after treatment with IVIG, but individual susceptibility varies greatly.
- Subjects
HEMOLYSIS &; hemolysins; INTRAVENOUS immunoglobulins; IDIOPATHIC thrombocytopenic purpura; BLOOD groups; ERYTHROCYTES; THERAPEUTICS; ABO blood group system; CLINICAL trials; COMPARATIVE studies; DISEASE susceptibility; IMMUNITY; IMMUNOGLOBULINS; RESEARCH methodology; MEDICAL cooperation; RESEARCH; THROMBOPENIC purpura; EVALUATION research; DISEASE complications
- Publication
Transfusion, 2017, Vol 57, Issue 11, p2629
- ISSN
0041-1132
- Publication type
journal article
- DOI
10.1111/trf.14289