Hemolysis induced cross-matching difficulty with intravenous immunoglobulin: a case report

Abstract

BackgroundIntravenous immunoglobulin is one of the most common modalities of treatment for Guillain–Barré syndrome. Although minor complications are easily preventable with pre-medications, rare complications like hemolysis occur at unexpected times and carry risks of repeated transfusions. A complication like difficulties in cross-matching blood is an uncommon event and is often not anticipated. We present one such rare case.Case presentationA 56-year-old man of Asian origin had presented to our hospital with rapidly progressive weakness of bilateral upper and lower limbs over 4 days. Guillain–Barré syndrome was diagnosed by nerve conduction velocity testing and lumbar puncture examination. On the third day of admission in hospital he was intubated because of respiratory failure. Intravenous immunoglobulin at 0.4 mg/kg per day for 5 days was planned and started. Our patient was scheduled for tracheostomy on a routine basis anticipating prolonged requirement of ventilator support. As the blood was being arranged, the blood bank facilities informed us about difficulties in cross-matching of the blood. Repeated samples and attempts at cross-matching were futile. After reviewing the available literature and diagnosing a case of hemolysis, relevant tests were performed and they were positive.ConclusionsAnti-A and anti-B antibody present in intravenous immunoglobulin preparations sensitize the red blood cells to hemolysis and this occurrence is often incriminated as a cause of cross-matching and sometimes blood grouping difficulty. Although a high dose of intravenous immunoglobulin or repeated courses are often cited as reasons for hemolysis, individual variability in responses is common and it is not surprising to see one like we had in our case.

Incidence and risk factors for intravenous immunoglobulin‐related hemolysis: A systematic review of clinical trial and real‐world populations

“…The number of hemolysis cases was slightly greater in females (nine cases out of 16 cases where sex was reported (56%), and patients were aged between 3 months to 75 years old). Of the 19 cases, seven were in pediatric patients (<18 years old), 30,35,39 three patients were aged between 18 and 50 years old, and nine were in patients over 50 years of age 31–34,36,37 . The most common indication was KD (seven cases 30,35,39 ) followed by GBS (six cases; including one patient with Miller Fisher syndrome, a subtype of GBS 31,33,34,37 ), ITP (two cases 34,36 ) or MG (two cases 31 ).…”

“…Of the 19 cases, seven were in pediatric patients (<18 years old), 30,35,39 three patients were aged between 18 and 50 years old, and nine were in patients over 50 years of age. [31][32][33][34]36,37 The most common indication was KD (seven cases 30,35,39 ) followed by GBS (six cases; including one patient with Miller Fisher syndrome, a subtype of GBS 31,33,34,37 ), ITP (two cases 34,36 ) or MG (two cases 31 ). Other cases reported CIDP 34 or nonischemic cardiomyopathy.…”

Pengaruh Lama Simpan Dan Tingkat Hemolisis Darah K2edta Resipien Terhadap Hasil Crossmatch Metode Gel

“…Pada dasarnya, hemolisis terjadi ketika sel darah merah menjadi rusak atau hancur. Sel darah merah mengandung molekul hemoglobin yang dilepaskan selama hemolisis menyebabkan serum atau plasma berwarna merah muda hingga merah 6 .…”