A pediatric case series of acute hemolysis after administration of intravenous immunoglobulin

Intravenous immunoglobulin (IVIG) is commonly used as an immune-modulatory treatment for patients with autoimmune and inflammatory diseases [1]. Antibody-mediated hemolysis of red blood cells (RBCs) after IVIG infusion is a recognized but rare side effect [2]. This retrospective case series describes four pediatric patients at a single institution who developed significant hemolytic reactions after treatment with IVIG for either Kawasaki disease or acute inflammatory demyelinating polyradiculoneuropathy. Patients ranged in age from 5 months to 14 years. The mean decrease in hemoglobin level after IVIG was 5.1 ± 0.36 g/dL (mean ± SD). Three of the four patients required RBC transfusion, and all the patients recovered spontaneously within 1 month of IVIG infusion. This case series illustrates a relatively uncommon, but potentially severe side effect of IVIG treatment, and demonstrates the importance of monitoring hemoglobin levels after IVIG therapy.