The role of inflammation in intravenous immune globulin-mediated hemolysis

Intravenous immune globulin (IVIG) therapy has shown great success in a number of autoimmune and inflammatory conditions and its use continues to increase worldwide. There is growing awareness of significant side effects of high‐dose IVIG: however, particularly severe hemolysis in patients that are...

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Bibliographic Details
Published in:Transfusion (Philadelphia, Pa.) Pa.), 2015-07, Vol.55 (S2), p.S65-S73
Main Authors: Pendergrast, Jacob, Willie-Ramharack, Kezia, Sampson, Lorna, Laroche, Vincent, Branch, Donald R.
Format: Article
Language:English
Subjects:
ABO Blood-Group System - immunology
Hemolysis - drug effects
Hemolysis - immunology
Humans
Immunoglobulins, Intravenous - adverse effects
Immunoglobulins, Intravenous - immunology
Immunoglobulins, Intravenous - therapeutic use
Immunologic Factors - adverse effects
Immunologic Factors - immunology
Immunologic Factors - therapeutic use
Inflammation
Inflammation - chemically induced
Inflammation - immunology
Inflammation - pathology
Interleukin 1 Receptor Antagonist Protein - immunology
Monocytes - immunology
Monocytes - pathology
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Summary:Intravenous immune globulin (IVIG) therapy has shown great success in a number of autoimmune and inflammatory conditions and its use continues to increase worldwide. There is growing awareness of significant side effects of high‐dose IVIG: however, particularly severe hemolysis in patients that are non–group O. It has been proposed that IVIG‐associated hemolysis may be heralded by an existing inflammatory condition. In the work presented herein, we have provided a review of the pathophysiology of inflammation, particularly as it applies in immune‐mediated red blood cell hemolysis, and a summary of previous publications that suggest an association between IVIG‐mediated hemolysis and a state of existing inflammation. In addition, preliminary results from a prospective study to address the mechanism of IVIG‐associated hemolysis are provided. These preliminary data support the idea of an existing inflammatory condition preceding overt hemolysis after high‐dose IVIG therapy that: 1) is restricted to non–group O patients, 2) is seen when using IVIG doses of more than 2 g/kg, 3) involves an activated mononuclear phagocyte system, 4) may be presaged by a significant increase in the anti‐inflammatory cytokine interleukin‐1 receptor agonist, and 5) is independent of secretor status.
ISSN:0041-1132
1537-2995
DOI:10.1111/trf.13097