Christine Verboon, Bianca van den Berg, Bart C. Jacobs, Pieter A. van Doorn; Rotterdam, the Netherlands
Submitted March 31, 2015
Nguyen et al. reported symptomatic anemia occurring in three of five patients with Guillain-Barre syndrome (GBS) or
Miler Fisher syndrome after successive courses of high-dose intravenous immunoglobulin (IVIg). [1] Two of these patients
had hemolysis requiring blood transfusion. Hemolysis may be caused by anti-A and anti-B blood group antibodies in IVIg. [2]
It was questioned whether this treatment regimen is safe, especially in patients with non-O blood types.
As the authors mention, an ongoing trial is investigating whether a second IVIg dose (SID) administered shortly
after standard IVIg is effective in GBS patients with poor prognosis. [3,4]
Acute hemolysis, requiring blood transfusion, is a known severe complications of IVIg. [5] In the SID-GBS trial,
55 patients were randomized and no acute hemolysis has hitherto been reported, although some patients received blood
transfusion during admission. Of the eight patients randomized at Erasmus Medical Center, one patient received a blood
transfusion because of slowly progressive anemia, probably related to hematuria and hemodilution. Studies like the SID-GBS
trial are necessary to find evidence to balance benefits and side-effects of a SID in GBS.
It is advisable to be aware hemolysis can occur in patients treated with repeated courses of IVIg. [1,2,5]
1. Nguyen TP, Biliciler S, Wahed A, Sheikh K. Occurrence of hemolytic anemia in patients with GBS treated with
high-dose IVIg. Neurol Neuroimmunol Neuroinflammation 2014;1:e50
2. Markvardsen LH, Christiansen I, Harbo T, Jakobsen J. Hemolytic anemia
following high dose intravenous immunoglobulin in patients with chronic neurological disorders. Eur. J. Neurol 2014; 21:
147-152
3. Walgaard C, Lingsma HF, Ruts L, van Doorn PA, Steyerberg EW, Jacobs BC.
Early recognition of poor prognosis in Guillain-Barre syndrome. Neurology
2001;76:968-75
4. Van den Berg B, Walgaard C, Drenthen J, Fokke C, Jacobs BC, van Doorn
PA. Guillain-Barre syndrome: pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol 2014;10:469-482
5. Berger M. Adverse effects of IgG Therapy. J Allergy Clin Immunol Pract
2013;6:558-566
For disclosures, please contact the editorial office at [email protected].
Nguyen et al. reported symptomatic anemia occurring in three of five patients with Guillain-Barre syndrome (GBS) or Miler Fisher syndrome after successive courses of high-dose intravenous immunoglobulin (IVIg). [1] Two of these patients had hemolysis requiring blood transfusion. Hemolysis may be caused by anti-A and anti-B blood group antibodies in IVIg. [2] It was questioned whether this treatment regimen is safe, especially in patients with non-O blood types.
As the authors mention, an ongoing trial is investigating whether a second IVIg dose (SID) administered shortly after standard IVIg is effective in GBS patients with poor prognosis. [3,4]
Acute hemolysis, requiring blood transfusion, is a known severe complications of IVIg. [5] In the SID-GBS trial, 55 patients were randomized and no acute hemolysis has hitherto been reported, although some patients received blood transfusion during admission. Of the eight patients randomized at Erasmus Medical Center, one patient received a blood transfusion because of slowly progressive anemia, probably related to hematuria and hemodilution. Studies like the SID-GBS trial are necessary to find evidence to balance benefits and side-effects of a SID in GBS.
It is advisable to be aware hemolysis can occur in patients treated with repeated courses of IVIg. [1,2,5]
1. Nguyen TP, Biliciler S, Wahed A, Sheikh K. Occurrence of hemolytic anemia in patients with GBS treated with high-dose IVIg. Neurol Neuroimmunol Neuroinflammation 2014;1:e50
2. Markvardsen LH, Christiansen I, Harbo T, Jakobsen J. Hemolytic anemia following high dose intravenous immunoglobulin in patients with chronic neurological disorders. Eur. J. Neurol 2014; 21: 147-152
3. Walgaard C, Lingsma HF, Ruts L, van Doorn PA, Steyerberg EW, Jacobs BC. Early recognition of poor prognosis in Guillain-Barre syndrome. Neurology 2001;76:968-75
4. Van den Berg B, Walgaard C, Drenthen J, Fokke C, Jacobs BC, van Doorn PA. Guillain-Barre syndrome: pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol 2014;10:469-482
5. Berger M. Adverse effects of IgG Therapy. J Allergy Clin Immunol Pract 2013;6:558-566
For disclosures, please contact the editorial office at [email protected].