Carboxyhemoglobin Levels in Neonatal Immune Hemolytic Jaundice Treated with Intravenous Gammaglobulin

Abstract

In order to examine the effect of intravenous immunoglobulin (IVIG) on the rate of hemolysis in immune hemolytic hyperbilirubinemia, we measured the carboxyhemoglobin levels of 5 newborn infants who were subjected to IVIG treatment. The pretreatment rate of hemolysis, in the 5 patients with isoimmune hemolytic jaundice (3 patients with Rh hemolytic disease of the newborn and 2 patients with ABO hemolytic disease of the newborn), as reflected by caboxyhemoglobin levels was higher than the rate of hemolysis in normal newborn infants. In 4 out of the 5 patients treated with IVIG, there was a rapid decline (>30%) of carboxyhemoglobin levels, a pattern which was different from that observed in normal newborn infants with no hemolytic jaundice and in 3 untreated patients with ABO hemolytic disease of the newborn. None of the treated patients required an exchange transfusion. Our preliminary results support the theory that the attenuation of jaundice observed following IVIG treatment in patients with immune hemolytic hyperbilirubinemia is caused, at least in part, by the reduction in hemolysis.

Immunoglobulin transfusion in hemolytic disease of the newborn: place in therapy

“…25 It has been proposed that IVIG blocks the Fc receptor and therefore blocks the binding of the antibody to the antigen. [26][27][28] With this blockade, hemolysis no longer occurs.…”

“…8,11 IVIG has been deemed safe, and is generally well tolerated with a limited side effect profile. 28 Hemolysis, acute renal failure, and sepsis in preterm infants have been reported. 29,30 More recently, an association with necrotizing enterocolitis has been described, but other factors in the development of necrotizing enterocolitis, such as prematurity and prenatal risk factors, could not be ruled out.…”

Question 2

“…Aggarwal et al (n = 26) used a cohort of patients all of whom received exchange transfusions within 6 h of birth and showed that IVIG administration reduced the need for subsequent exchange transfusions 17. The case series by Ergaz et al found a reduction in carboxyhaemoglobin levels (>30%) with the use of IVIG and exchange transfusion was avoided 18. This supports the theory that attenuation of jaundice by IVIG is, at least in part, attributable to a reduction in haemolysis.…”

Necrotizing enterocolitis following the use of intravenous immunoglobulin for haemolytic disease of the newborn

“…The putative mechanism of IVIg action is non‐specific blockade of Fc receptors. Thus, it has been shown that carboxy‐haemoglobin levels, a sensitive index of the presence of haemolysis, declined after IVIg administration in sensitized infants (5). However, although studies performed showed a significant reduction in the need for exchange transfusion in those treated with IVIg the applicability of the results is limited because the number of studies and infants included was small and none of the studies was of high quality (6) and IVIg may also cause important adverse reactions (for review see Ref.…”