静脉注射免疫（γ）球蛋白后发生的溶血性输血反应：病例系列分析
Hemolytic transfusion reactions after administration of intravenous immune (gamma) globulin: a case series analysis.
作者信息
Daw Zohra, Padmore Ruth, Neurath Doris, Cober Nancy, Tokessy Melanie, Desjardins Diane, Olberg Bernhard, Tinmouth Alan, Giulivi Antonio
机构信息
Division of Hematology and Transfusion Medicine, Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.
出版信息
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.
背景
本病例系列总结了我们对大量静脉注射免疫（γ）球蛋白（IVIG）后溶血反应的观察结果。
研究设计与方法
通过静脉注射免疫球蛋白后血红蛋白下降且无其他合理解释来确定溶血病例。
结果
在渥太华医院约1000例接受静脉注射免疫球蛋白的患者中，在2年半的时间里确定了16例（1.6%）。这些患者的特征包括大剂量静脉注射免疫球蛋白、女性、非O血型以及潜在的炎症状态。
结论
大剂量静脉注射免疫球蛋白后可能发生显著溶血。提出了溶血的两步机制，即ABO同种血凝素致敏，随后被活化巨噬细胞吞噬。本文介绍了一个有助于早期发现此类病例的简单方案。
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