Intravenous immunoglobulin–related hemolysis in patients treated for Kawasaki disease

Luban, Naomi L.C.; Wong, Edward C.C.; Lobo, Rodolfo Henrich; Pary, Philippe; Duke, Sarah M.

doi:10.1111/trf.13089

Cited by 32 publications

(31 citation statements)

References 29 publications

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“…[164][165][166] Recently, Coombs-positive hemolytic anemia complicating IVIG administration has been reported, especially in individuals with AB blood type. [167][168][169] Aseptic meningitis can occur as a result of IVIG infusion, but it resolves quickly without neurological sequelae. 170 Clinical studies comparing the efficacy of different immune globulin products have been conflicting.…”

Section: Intravenous Immunoglobulinmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

2,863

4,124

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BACKGROUND:Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. METHODS AND RESULTS:To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and longterm outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. CONCLUSIONS:These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances. K awasaki disease (KD) is an acute, self-limited febrile illness of unknown cause that predominantly affects children <5 years of age. When initially described, the potential for coronary artery complications was not appreciated. KD is now the most common cause of acquired heart disease in children in developed countries. In the absence of pathognomonic tests, the diagnosis continues to rest on the identification of principal clinical findings and the exclusion of other clinically similar entities with known causes. Timely initiation of treatment with intravenous immunoglobulin (IVIG) has reduced the incidence of coronary artery aneurysms defined from absolute luminal dimensions from 25% to ≈4%. Ongoing studies with additional therapies have not substantially reduced this residual risk. The long-term prognosis is determined by the initial and current level of coronary artery involvement. Certain subsets of patients are at risk for myocardial ischemia from coronary artery thrombosis and stenoses. Medical management of such patients hinges on judicious use of thromboprophylaxis and vigilance to identify evolving stenoses. Invasive revascul...

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Section: Intravenous Immunoglobulinmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

2,863

4,124

View full text Add to dashboard Cite

show abstract

“…21 Two recent case series have raised an important safety concern of hemolytic anemia following a second infusion of IVIG in patients with either A or B blood groups. 22,23 This newly emergent problem may be related to changes in antibody screening of donor blood for IVIG lots, but the cause for the higher anti-A and anti-B titers has not yet been definitively identified.…”

Section: Choosing Adjunctive Therapies For Kd Second Infusion Of Ivigmentioning

confidence: 99%

Adjunctive therapies for Kawasaki disease

Campbell

Burns

2016

Journal of Infection

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“…[29] Haemolysis after Gammagard® infusion is considered to be usually mild, but many patients require RBC transfusion, according to the overview of the literature covering not only KD patients. [30] The etiology of haemolysis in KD patients who received IVIG is multifactorial. The most common one is the presence of transient, passively acquired antibodies (confirmed by positive DAT that causes direct antibodymediated attack).…”

Section: Case Discussionmentioning

confidence: 99%

“…[12,31] Other risk factors for haemolytic anaemia are the presence of anaemia due to inflammation in KD and the immune dysregulation in the disease. [30] Another possible mechanism is erythrophagocytosis due to the presence of high-molecularweight IgG complexes in IVIG binding to complement receptors on RBCs. [32] In the light of available evidence, haemolytic anaemia should be considered in KD patients receiving IVIG, especially in those who need a second infusion.…”

Section: Case Discussionmentioning

confidence: 99%

Kawasaki disease and acute haemolytic anaemia after two IVIG infusions

Telcharova-Mihaylovska

Stefanov

Nikolova

2016

Biotechnology & Biotechnological Equipment

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Kawasaki disease (KD) is one of the most common vasculitis disorders of childhood, affecting predominantly medium-sized arteries, particularly the coronary arteries. For treatment, high-dose intravenous immunoglobulin (IVIG) is indicated. IVIG infusions are usually safe and well tolerated even though serious complications can be observed. We present a brief overview of KD and report a two-year-old girl with KD and two IVIG infusions (Gammagard®) because of persistent fever after the completion of the first IVIG. Haemolytic anaemia developed after IVIG retreatment. The direct antiglobulin test after haemolysis was positive. The etiology of the haemolysis was related to the presence of transient, passively acquired antibodies that cause a direct antibody-mediated attack. There are few reports of haemolytic anaemia after IVIG infusions. The haemolysis in KD is dosedependent and occurs more frequently after the second IVIG dose. Non-0 blood group patients are at greater risk. Another factor increasing the risk of haemolysis is also the presence of anaemia due to inflammation in KD.

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Intravenous immunoglobulin–related hemolysis in patients treated for Kawasaki disease

Cited by 32 publications

References 29 publications

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Adjunctive therapies for Kawasaki disease

Kawasaki disease and acute haemolytic anaemia after two IVIG infusions

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