Plasma exchange as a necessary prerequisite for the induction of remission by human immunoglobulin in auto-immune haemolytic anaemia.

High-dosage intravenous human immunoglobulin G (i.v. IgG) has been used with varying degrees of success to treat a variety of auto-immune disorders which are frequently characterized by a predominantly pathogenic auto-antibody. The present report, in which consistent control and ultimately complete remission of a resistant auto-immune haemolytic anaemia (AIHA) was achieved by carrying out preliminary plasma exchange as a crucial prelude to the administration of high-dose i.v. IgG provides not only insight into the immuno-regulatory action of the IgG but also raises the interesting possibility that similar benefit might be obtained by such combined procedures in other resistant auto-immune diseases.