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Acute haemolytic anaemia: case report A 32-year-old man developed acute haemolytic anaemia during treatment with immune globulin for Guillain-Barre syndrome. The man, who was diagnosed with Guillain-Barre syndrome (GBS), received high-dose IV immune globulin (IVIG) 0.4 g/kg/day for five successive days. On the day of completion of immune globulin therapy, his haemoglobin was 12.4 mg/dL. At home, he experienced fall while ambulating following which he was admitted to the emergency department (ED). At ED, physical examination revealed lower extremity weakness and scleral icterus. Blood analysis showed acute anaemia with haemoglobin of 8.3 mg/dL. Further laboratory tests revealed elevated indirect bilirubin, LDH and reticulocyte count with decreased haptoglobin, which was consistent with haemolytic anaemia. Peripheral smear demonstrated nucleated RBCs. Based on a negative direct Coombs test, autoimmune haemolysis was ruled out. He was diagnosed with immune globulin-induced haemolytic anaemia [time to reaction onset not stated]. The man’s haemolytic anaemia was managed conservatively with stable haemoglobin above 8 mg/dL throughout his hospital stay. Author comment: "Hemolytic anemia is one of the rare complication following [immune globulin] administration and hemoglobin should be monitored closely during treatment course as well as 24 hours after the completion of [immune globulin] and at one-week post-discharge". Raj R, et al. A case of acute hemolytic anemia following high dose intravenous immunoglobulin (IVIG). Journal of Hospital Medicine 13 (Suppl. 1): abstr. 808, No. 4, Apr 2018. Available from: URL: https://www.shmabstracts.com/abstract/acase-of-acute-hemolytic-anemia-following-high-dose-intravenous-immunoglobulin803432350 ivig/ [abstract] - USA

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Reactions 9 Nov 2019 No. 1778