A prospective observational study of the incidence, natural history, and risk factors for intravenous immunoglobulin-mediated hemolysis
| Autor: | Katerina Pavenski, Jeannie Callum, Lorna Sampson Riden, Christine Cserti-Gazdewich, Tik Nga Tong, Nagina Parmar, Chantal Armali, Aziz Jiwajee, Yulia Lin, Donald R. Branch, Jacob Pendergrast, Lani Lieberman, Beth Binnington, George Tomlinson, Kezia Willie-Ramharack, Wendy Lau, Nadine Shehata |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Canada Immunology 030204 cardiovascular system & hematology Gastroenterology Hemolysis Subclass Monocytes ABO Blood-Group System 03 medical and health sciences Pharmacovigilance 0302 clinical medicine Risk Factors hemic and lymphatic diseases Internal medicine ABO blood group system medicine Immunology and Allergy Humans Prospective Studies Infusions Intravenous Aged Univariate analysis biology business.industry Incidence (epidemiology) Incidence Intracellular Signaling Peptides and Proteins Immunoglobulins Intravenous Complement C4 Hematology Complement C3 Middle Aged medicine.disease Natural history Hemagglutinins Immunoglobulin G Ferritins biology.protein Cytokines Female Antibody business 030215 immunology |
| Zdroj: | TransfusionREFERENCES. 61(4) |
| ISSN: | 1537-2995 |
| Popis: | Background Intravenous Immune Globulin (IVIG) is used to treat numerous immune-mediated and inflammatory conditions. There is growing awareness of hemolysis, occasionally severe, as a side-effect of this therapy. While most cases are associated with anti-A and/or anti-B isoagglutinins, the frequency and mechanism of hemolysis remain poorly characterized. Study design and methods A prospective observational study was conducted to determine incidence, natural history and risk factors for IVIG-mediated hemolysis. A total of 99 infusions of high-dose IVIG (2 g/kg or higher) administered to 78 non-group O patients were monitored and graded according to Canadian IVIG Hemolysis Pharmacovigilance Group. Serum ferritin and C3/C4 levels were monitored as indicators of macrophage activation and complement consumption, respectively. Supplementary investigations included assessment for ABO zygosity, Secretor status, FcR polymorphisms, eluate IgG subclass, monocyte monolayer assay, and a panel of cytokines. Results Hemolysis was observed in 32 of 99 (32%) of infusions, with 19 of 99 (19%) grade 2 or higher. Hemolysis was only apparent 5-10 days after a completed IVIG infusion in 84% of cases and was associated with increases in serum ferritin without complement-consumption. In univariate analysis, increased risk was observed in group AB patients, first-time IVIG recipients, those not taking immuosuppressive medications, or patients treated with a specific IVIG brand; however, in multivariate analysis, product association was no longer observed. No other patient- or practice-related risk factors were identified. Conclusion IVIG-mediated hemolysis is common and frequently severe. Monitoring for 5-10 days following an infusion should be considered in non-O patients receiving high-dose IVIG with known risk factors. |
| Databáze: | OpenAIRE |
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