Year: 2024
Type: article
Study design: Case Report
Abstract: Objective N/A. Background Intravenous immunoglobulin (IVIG) is commonly used to treat neurological conditions, including CNS demyelination disorders. Although rare, IVIG-induced hemolytic anemia is a potentially serious complication, particularly with high-dose IVIG administration. This complication is often overlooked, leading to treatment delays and unfavorable outcomes. Here, we present two cases of hemolytic anemia following IVIG treatment in patients with neuromyelitis optica spectrum disorder (NMOSD). Design/Methods N/A. Results Case 1: A 39-year-old male with seronegative NMOSD received immunomodulation therapy with a combination of Rituximab and mycophenolate. Despite this treatment, he continued to experience recurrent symptom flares and was found to have new or active lesions on brain and spine MRI. A high dose of IVIG (total dosage 2g/kg) was administered in three infusions. After the second infusion, the patient developed hematuria and mild anemia but did not experience other systemic symptoms. These complications were transient. Case 2: A 51-year-old female with AQP4-positive NMOSD received IVIG (1g/kg split over two days) in addition to Rituximab therapy. Two days after the infusion, she developed chills, followed by intermittent low-grade fever, progressive fatigue, body pain/aches, and difficulty with ambulation two weeks later. Imaging did not reveal active or new lesions. Laboratory findings showed severe anemia, high reticulocyte count (Table 1), elevated ESR, CRP, and LDH, along with reduced haptoglobin. Peripheral smear indicated mild-to-moderate anisopoikilocytosis. The patient symptoms gradually improved, and along with the normalization of laboratory values. Both patients had AB blood type. Conclusions The cases we presented demonstrated diverse clinical presentations and outcomes, highlighting the necessity for attentive monitoring and prompt management of such complications. Clinicians must be aware of risk factors like non-O blood types and should consider alternative treatment approaches or dosage modifications when prescribing IVIG to patients with NMOSD or other CNS demyelination disorders to mitigate the risk of hemolytic complications.
Source: Neurology
Authors: Lingxuan Li, Mark Waheed, Ning Zhong
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4403206795