INTRAVENOUS IMMUNE GLOBULIN IN NEONATAL IMMUNE HEMOLYTIC-DISEASE - DOES IT REDUCE HEMOLYSIS

We studied the effect of intravenous immune globulin (IVIG) on hemolys is in term: hyperbilirubinemic, Coombs' positive infants utilizing mea surement of carboxyhemoglobin fraction corrected for inhaled carbon mo noxide (COHbc), a sensitive indicator of hemolysis. COHbc values were determined before and after IVIG infusion. In those babies who respond ed with a decrease in serum total bilirubin (n = 19), no exchange tran sfusions were required and COHbc levels decreased significantly by 24 h post-IVIG from 1.37 +/- 0.31 to 1.12 +/- 0.26% tHb (p < 0.0001). The re were no corresponding decreases in COHbc levels (1.89 +/- 0.54 to 1 .82 +/- 0.48% tHb; p > 0.05) among those whose serum bilirubin levels did not decrease in response to IVIG (n = 7), and all of these infants required exchange transfusions. Furthermore, the extent of the decrea se in COHbc was related to the degree of decrease in serum bilirubin l evels, such that the percentage decrease of bilirubin at 24 h was dire ctly correlated with the percentage decrease of COHbc at 24 h (p = 0.0 07). We conclude that IVIG, when successful, inhibits hemolysis in the se infants.