A teenage patient who received intravenous immunoglobulin (IVIG) for pyoderma gangrenosum was diagnosed with IVIG-induced hemolytic anemia after complaining of headaches and newly developed rashes, according to a case report recently published in the Annals of Internal Medicine Clinical Cases.
IVIG is used to treat a number of conditions, including fetal and neonatal alloimmune thrombocytopenia (FNAIT).
A 19-year-old female patient presented with headaches and a newly developed purplish-yellow rash in her lower limbs. She had a medical history of Crohn’s disease, which is an inflammatory bowel disorder. She previously had a portion of her intestine surgically removed.
Among other medications, the patient received IVIG for refractory pyoderma gangrenosum, an inflammatory skin condition characterized by enlarging ulcers. After she received her third dose of the medication, she started complaining of headaches. In addition, she experienced chest pain, an increased heart rate, the sensation of feeling about to faint, and floaters made more obvious by bright light.
A physical examination showed blotchy, net-like livedoid skin patches in both her upper and lower limbs. There were pyoderma gangrenosum ulcers on her right flank that showed signs of healing. Laboratory investigations showed marked anemia (hemoglobin levels: 7.5 g/dL). She had a positive direct Coombs test. An ophthalmological examination was inconclusive.
Read more about FNAIT testing and diagnosis
Her symptoms began right after a third IVIG infusion and she was diagnosed with IVIG-induced hemolytic anemia, which is a condition in which IVIG causes drug-induced destruction of the red blood cells.
The patient was administered intravenous fluids alongside folic acid supplementation. The patient did not receive any red blood cell transfusions but her hemoglobin spontaneously improved to 8.8 g/dL. Two months after presentation, her symptoms had resolved, and a repeat direct Coombs test was found to be negative.
“Given the increasing use of IVIG in clinical practice, increased awareness of the potential for rapid hemolysis following moderate-to-large cumulative IVIG doses is essential,” the authors of the report wrote.
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