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Intravenous immunoglobulin (IVIg) is used in the treatment of several medical illness and renal disorders. One of major use of IV ig is in anti body mediated renal allograt rejection. in general IVIg is safe,however several side effect and potential serious complications may associated with IVIg including anemia in particular hemolytic anemia .
We reported a 42 years old female patient status post renal transplantation in 2017 .the etiology of CKD is secondery to type 1 DM.4 years post renal tranplantion sustained increased in serum creatinine hens she underwent renal graft biopsy and showed antibody mediated rejection she was treated with pulse steroid ,rituximab and IVIg in a dose of 2g/kg .
Few days later her creatinine improved and stabilised but she sustained significant anemia and drop in HB from 12 mg/dl to around 7 with symtomatoc anemia .she was invistigated throughly ,no evidance of blood loss no Gastrointestinal bleeding,no gynecological bleeding ,heamolytic work up unremarkable.later on HB stabilized. However she required blood transfusion.
In 2023 her creatinine increased gradually again and underwent another renal graft biopsy and showe antibody mediated rejection treated again with IVIg and again she developed symtomatoc anemia all anemia work up performed and again no evidance of blood loss and heamlytic work up was unremarkable.
Our defferntial diagnosis was likly the cause of anemia related to IVIG.although this assciated with heamolysis but the heamolytic work up was egative in our patient.
Intravenous immunoglobulins (IVIg) used in management of several immune -mediated conditions .
is used in renal transplantation for desensitization and treatment of antibody-mediated rejection (AMR).
anemia in particular heamlytic anemia may associated with high dose IVIg .the incidabce and mechanisim is not well understood. Some risk factors include high titer anti-A/B IgG antibodies, non-O blood type of the recipient and administration of liquid IVIG preparations.
Its recommeded to monitor HB after IVIG and if HB decreased further hemoltic work up will be needed .in suspected cases
direct antiglobulin testing may be requisted , searching for antibodies to the patients' own blood type. In one series of 42 patients received IVIG 12 developed passive sensitization with antibodies to their own blood group antigens after receiving IVIg.
In another review its mentioned in most commercially prepared IVIG there is antibodies to blood group antigen.however most patients don not develop clinically significant anemia.
In our patient she has sever anemia but the heamolytic work up was unremarkable whuch raise the suspension probably there is another mechanism may cause anemia in patient receiving IVIg.
Intravenous Immune Globulin (IVIg) commonly used in renal disorder.high dose may associted with anemia of heamolytic type.exact mechanism not well known .monitoring of Hb post IVIG is recommended particularly in high risk patient like non O -patients.
Increase awareness about this complication will help in early detection of anemia , allow early intervention and this will prevent any further morbidity.