Naslov
Haemoylsis in a premature newborn after treatment with intravenous immunoglobulin due to passively transmitted anti-D

Autori
Lukić, Marija ; Raos, Mirela ; Plenković, Fini ; Golubić Čepulić, Branka

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
Vox Sanquinis, International Journal of Transfusion Medicine / - Volume 116, S 1 : John Wiley & Sons, 2021, 95-95

Skup
31st Regional ISBT Congress ISBT in Focus

Mjesto i datum
Online, 02.06.2021. - 08.06.2021

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
hemoliza, imunoglobulin
(haemolysis, Immunoglobulin)

Sažetak
Background: Intravenous immunoglobulin (IVIG) is the most widely used plasma component in the world. It is approved for the treatment of increasing number of conditions associated with immunodeficiency. Commercial immune globulins, including IVIG, may contain measurable quantities of IgG class antibodies, mostly of anti-A or anti-B specificity, but also other non-ABO antibodies may be present. So far, few cases of haemolytic anaemias, most often due to anti-D or anti-A have been reported, as manufacturers tend to lower the titre of red blood cell antibodies. Aims: The aim of this case report was to point out the potential severity of haemolysis in a D- positive newborn after IVIG treatment due to passively transmitted anti-D. Methods: We report on a case of haemolysis in a premature newborn after treatment with IVIG due to passively transmitted anti-D. Results: The patient was a premature born male, born at 34th weeks of gestation, with a diagnosis of combined immunodeficiency with multiple intestinal atresia. His blood type was determined to be A Dpositive. Direct antiglobulin test was negative. Mother´s blood type was determined to be A D-positive. In her blood no alloantibodies were detected. At birth, haemoglobin, total bilirubin and direct bilirubin were within reference values. Immediately after birth, partial resection of the small intestine was performed, with the formation of gastroduodenal LL anastomosis and jejunostomy, after which the patient developed sepsis and thrombocytopenia. On days 18 and 20 of patient’s life, he was treated with IVIG. Shortly thereafter, haemoglobin decreased significantly. Other haemolytic markers, such as total bilirubin, direct bilirubin and lactate dehydrogenase, were increased. Under the suspicion of an immune haemolysis, the patient’s sample was sent to our laboratory for the serological investigation. Patient had a positive direct antiglobulin test and the red blood cell antibody screening test was negative. In the eluate, anti-D was identified. Anti-D was also identified in the IVIG, that was used for the patient’s treatment. The patient was additionally transfused with A D-negative red blood cell units, and he had a corresponding increase of haemoglobin value. Summary/Conclusions: This case illustrates the potential severity of haemolysis in a D-positive newborn after IVIG treatment due to passively transmitted anti-D. Haemolytic anaemias due to passively transmitted red blood cell antibodies by IVIG treatment may be missed by the routine clinician’s practice. Clinicians need to be alerted of the possible haemolysis after IVIG treatment. Until then, haemolysis remains an under-recognized complication of IVIG therapy, and hence the exact incidence of haemolytic anaemia.

Izvorni jezik
Engleski

POVEZANOST RADA