Hemolytic transfusion reactions after administration of intravenous immune (gamma) globulin: a case series analysis

Transfusion. 2008 Aug;48(8):1598-601. doi: 10.1111/j.1537-2995.2008.01721.x. Epub 2008 May 2.


Background: This case series summarizes our observations of hemolytic reactions after the administration of large amounts of intravenous immune (gamma) globulin (IVIG).

Study design and methods: Cases of hemolysis were identified by a decrease in hemoglobin not otherwise explained following IVIG administration.

Results: Sixteen cases were identified over a 2 1/2-year period at the Ottawa Hospital of approximately 1000 patients receiving IVIG (1.6%). Characteristics of these patients include a large dose of IVIG, female sex, non-O blood group, and underlying inflammatory state.

Conclusions: Significant hemolysis may occur after the administration of large doses of IVIG. A two-step mechanism of hemolysis is proposed, sensitization by ABO isohemagglutinins followed by phagocytosis by activated macrophages. A simple protocol to facilitate the early detection of such cases is presented.

MeSH terms

  • ABO Blood-Group System
  • Adult
  • Aged
  • Anemia, Hemolytic / epidemiology*
  • Anemia, Hemolytic / etiology*
  • Biomarkers / blood
  • Dose-Response Relationship, Immunologic
  • Female
  • Hemolysis*
  • Humans
  • Immunoglobulins, Intravenous / adverse effects*
  • Incidence
  • Male
  • Middle Aged
  • Risk Factors
  • Severity of Illness Index
  • Sex Distribution


  • ABO Blood-Group System
  • Biomarkers
  • Immunoglobulins, Intravenous