2012年9月6日の New England Journal of Medicineに、Guillain-Barré症候群に対する免疫グロブリン大量療法 (IVIg) に合併した重度貧血の 2症例が報告されました。IVIgは溶血性貧血のリスクとして知られています。

IVIG — A Hemolytic Culprit

The administration of intravenous immune globulin (IVIG) is an established treatment for deficiency states and other immune-mediated disorders. It is used extensively in patients with neurologic diseases and is licensed for the treatment of Guillain–Barré syndrome.

Large doses of IVIG have been recognized as a cause of hemolytic anemia, which occurs by means of passive transfusion; this rare complication has been given little attention. We report here on two patients with Guillain–Barré syndrome who were seen in consultation because of acute severe anemia. The patients presented within 1 week of each other.

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Adverse reactions to treatment with IVIG include headache, renal insufficiency, hepatitis C, meningeal irritation, and thrombosis. The passive transfer of anti-A or anti-B antibodies in IVIG has been well recognized,1 as has the transfer of anti-Rh antibodies; passive transfer of antibodies to viral infection, without transmittal of the virus, also occurs. Many clinicians are little aware of this complication and are usually bewildered by the sequelae. It is impractical to evaluate a patient’s serologic state before administering IVIG.

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Hemolysis is self-limiting, and the transfusion of type O packed red cells should be used to treat the anemia.

IVIG contains multiple antibodies that can have unexpected consequences, including hemolysis and false positive results on serologic tests. Physicians should be aware of these rare sequelae so they will be prepared to manage them.

個人的には IVIgでの合併症はまだ経験がありませんが、IVIgは神経内科領域では比較的よく行いますし、こうした合併症の情報は押さえておかないといけませんね。

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