Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea.
J Small Anim Pract. 2022 Jun;63(6):482-485. doi: 10.1111/jsap.13449. Epub 2021 Dec 7.
A 2-year-old mixed breed dog presented with a 1-year history of crust and erosion on the nasal planum. Because histopathological examination revealed ruptured intraepidermal pustules and superficial dermal inflammation, the dog was diagnosed with pemphigus foliaceus. Human intravenous immunoglobulin was administered in two consecutive doses of 0.5 g/kg/day due to poor therapeutic response to previous immunosuppressive therapy. From Day 3 after the first dose of human intravenous immunoglobulin, tachypnoea, pale mucous membrane, haemoglobinuria and haemoglobinemia were observed, thus confirming haemolytic anaemia. Other drug-induced haemolytic anaemias were excluded because no additional drugs had been administered before the haemolysis occurred. Immune-mediated haemolytic anaemia was also excluded because the direct antiglobulin test was negative. Two transfusions were performed, and haemolysis was not observed from Day 4 of haemolytic anaemia onset. In conclusion, human intravenous immunoglobulin-induced haemolytic anaemia should be considered in dogs that develop haemolysis following the administration of human intravenous immunoglobulin.
一只 2 岁混种犬，有 1 年鼻甲骨出现结痂和糜烂的病史。因为组织病理学检查显示表皮内脓疱破裂和真皮浅层炎症，所以诊断为落叶型天疱疮。由于对之前的免疫抑制治疗反应不佳，给予了两次连续剂量 0.5 g/kg/天的人静脉用免疫球蛋白。在第一次人静脉用免疫球蛋白给药后第 3 天，观察到呼吸急促、黏膜苍白、血红蛋白尿和血红蛋白血症，从而确诊为溶血性贫血。排除了其他药物引起的溶血性贫血，因为在发生溶血之前没有给予其他药物。也排除了免疫介导的溶血性贫血，因为直接抗球蛋白试验为阴性。进行了两次输血，从溶血性贫血发病的第 4 天起，未观察到溶血。总之，在给予人静脉用免疫球蛋白后发生溶血的犬中，应考虑人静脉用免疫球蛋白引起的溶血性贫血。
