Intravenous immunoglobulin (IVIG)), used at high-dose (>1-2 g/kg), for treatment of a variety of autoimmune and inflammatory diseases has an impressive safety record since its first use in 1981 to treat ITP. However, changes in manufacturing around 2007 to increase the quality and quantity of IgG in the product, also increased the concentration of IgG ABO isoagglutinins, anti-A and anti-B, contained in some manufacturers’ product. These antibodies can result in severe and sometimes life-threatening hemolysis when administered to people of non-blood group O phenotype. Recently, some manufacturers have changed their manufacturing practices to produce IVIG having very low isoagglutinin titers. Increased awareness of hemolysis associated with IVIG is timely because this is a surprisingly frequent, occasionally severe, under-appreciated problem. Post-IVIG hemolysis can be anticipated based on recipient blood group and state of inflammation.
This session will review the history of use of IVIG and its manufacturing processes, provide evidence and incidence for IVIG-associated hemolysis, discuss the current known risk factors and mechanism of hemolysis, and provide an evidence-based assessment of best practices for the use of IVIG products to minimize hemolysis and unnecessary morbidity in patients receiving these products. Attendees will be invited to participate by answering multiple choice questions regarding their experiences with IVIG-associated hemolysis, including monitoring patients and case reports.
All relevant financial relationships have been mitigated.
Explain the different manufacturing processes used to produce IVIG with different isoagglutinin titers
Identify the risks factors for IVIG-associated hemolysis
Recommend simple means to reduce IVIG-associated hemolysis
Donald Branch, BS, MT(ASCP)SBB, PhD:
CSL Behring: Consultant, Grant/Research Support (Secondary Investigators need not disclose)
VeroCarb: Stock Shareholder (self-managed)
Health Canada via Canadian Blood Services: Grant/Research Support, Full-time/Part-time Employee
Grifols: Grant/Research Support
Jacob Pendergrast, MD:
CSL Behring: Consultant
Sietse Nagelkerke, MD, PhD:
Nothing to Disclose
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AM22-19-O: (On-Demand) Hemolysis After High-Dose Intravenous Immunoglobulin: An Under-Appreciated Sequelae (Enduring) Evaluation