Hemolysis related to intravenous immunoglobulins is dependent on the presence of anti-blood group A and B antibodies and individual susceptibility.

Autor: Mielke O; CSL Behring GmbH, Marburg, Germany., Fontana S; Interregional Blood Transfusion Service SRC, Bern, Switzerland., Goranova-Marinova V; University Hospital 'Sv. Georgi' and Medical University Plovdiv, Plovdiv, Bulgaria., Shebl A; CSL Behring GmbH, Marburg, Germany., Spycher MO; CSL Behring AG, Bern, Switzerland., Wymann S; CSL Behring AG, Bern, Switzerland., Durn BL; CSL Behring LLC, King of Prussia, Pennsylvania., Lawo JP; CSL Behring GmbH, Marburg, Germany., Hubsch A; CSL Behring AG, Bern, Switzerland., Salama A; Institut für Transfusionsmedizin, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Jazyk: angličtina
Zdroj: Transfusion [Transfusion] 2017 Nov; Vol. 57 (11), pp. 2629-2638. Date of Electronic Publication: 2017 Aug 25.
DOI: 10.1111/trf.14289
Abstrakt: Background: 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.
Study Design and Methods: A prospective, open-label, multicenter, single-arm clinical trial in 57 patients with immune thrombocytopenia treated with IVIG (Privigen, CSL Behring) was conducted.
Results: 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.
Conclusion: Isoagglutinins are involved in clinically nonsignificant hemolysis after treatment with IVIG, but individual susceptibility varies greatly.
(© 2017 The Authors Transfusion published by Wiley Periodicals, Inc. on behalf of AABB.)
Databáze: MEDLINE
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