Intravenous immunoglobulin-associated hemolysis: risk factors, challenges, and solutions

Abstract

Abstract: Clinically significant hemolysis associated with intravenous immunoglobulin (IVIG) administration has recently been identified as a major problem requiring special attention, after increased incidence has been documented by US FDA since 2011. IVIG-associated hemolysis remains an under-recognized complication of IVIG therapy, and hence the exact incidence of hemolytic anemia induced by high dose IVIG is not clear. Patients at high risk of IVIG-associated hemolysis are non-O blood group recipients who receive high-dose IVIG for inflammatory or autoimmune disorder. Due to the immunomodulatory potential of high-dose IVIG, the clinical indications have increased over time. The objective of this article is to discuss the epidemiology, risk factors, and challenges of IVIG-associated hemolysis. Strategies to reduce the incidence of clinically significant hemolysis in patients treated with IVIG products and potential avenues for further research in this field are also discussed. Keywords: IVIG, immunoglobulins, hemolysis, ABO, isoagglutinins, hemolytic anemia