%0 Journal Article
%T Hemolytic anemia following intravenous immunoglobulin therapy in patients treated for Kawasaki disease: a report of 4 cases
%A Roberta Berard
%A Blair Whittemore
%A Rosie Scuccimarri
%J Pediatric Rheumatology
%D 2012
%I BioMed Central
%R 10.1186/1546-0096-10-10
%X We describe 4 patients with significant hemolytic anemia following treatment with IVIG for Kawasaki disease (KD). Direct antibody mediated attack as one of the mechanisms for hemolysis, in this population, is supported by the demonstration of specific blood group antibodies in addition to a positive direct antiglobulin test in our patients.Clinicians should be aware of this complication and hemoglobin should be closely monitored following high dose IVIG therapy.KD is a systemic vasculitis in which the major complication is the development of coronary artery aneurysms (CAA). Treatment with intravenous immunoglobulin (IVIG) significantly lowers the incidence of CAA. Standard therapy for the treatment of KD is high dose IVIG (2 g/kg) and aspirin. Retreatment with IVIG is administered for persistence of fever ¡Ý 36 h after the first infusion. Persistence of fever after initial IVIG therapy is estimated to occur in approximately 10% - 20% of cases [1].IVIG is used in high doses, most frequently at 2 g/kg, as an immunomodulatory agent [2]. It is a pooled blood product acquired from thousands of blood donors and it contains measurable levels of anti-A and anti-B (IgG subclass) as well as non-ABO erythrocyte antibodies (e.g. anti-D) [3]. IVIG is considered to be a safe product that is generally well tolerated. Hemolysis is a rarely reported side effect of IVIG. It occurs more commonly in those patients who receive high-dose IVIG [2,4] as is used in the treatment of KD. In the literature, there are 6 reported cases of children with hemolytic anemia following IVIG treatment for KD [4-7]. In this report, we describe 4 patients, all from a single centre, who developed hemolytic anemia following IVIG treatment for KD. To our knowledge, this is one of the largest case series describing this complication in this patient population.Significant hemolysis was noted in 4 out of 25 (16%) patients diagnosed and treated for KD at our centre during a 14-month interval. In this cohort of 25
%K Direct antiglobulin test
%K Isohemagglutinins
%K Retreatment
%U http://www.ped-rheum.com/content/10/1/10