HIGH-DOSE INTRAVENOUS IMMUNOGLOBULIN IN NON-ABO TRANSFUSION INCOMPATIBILITY

The administration of intravenous immunoglobulin (IVIG) in immune and autoimmune diseases led us to use this agent to ameliorate or prevent the consequences of non-ABO incompatible transfusions in patients who need this form of therapy. IVIG (400 mg/kg/day) was infused within 24 h of transfusion in 5 patients with: (1) intestinal angiodysplasia, ga strointestinal bleeding, and anti-Kp(b); (2) paroxysmal nocturnal hemo globinuria, anti-c, anti E, Anti Fy(b), anti-K and autoantibodies; (3) lymphoma and autoimmune hemolytic anemia (AIHA); (4) systemic lupus e rythematosus (SLE), AIHA, and anti-D, and (5) SLE and AHIA. A sustaine d increase in hematocrit was noted and no transfusion reaction develop ed in any of the cases. A single dose of pretransfusion IVIG may there fore be a useful therapeutic alternative in patients for whom no compa tible blood is available. Patients with severe anemia, allo- and autoa ntibodies, either showing hemolysis in their pathophysiology or not, c ause a serious problem in any transfusion center, especially when deal ing with emergencies. In order to reduce the risks of incompatible tra nsfusions, different modalities have previously been attempted, all wi th poor results. In 1989 we reported the successful use of pretransfus ional high-dose intravenous immunoglobulin (IVIG) in a patient with ga strointestinal bleeding and anti-Kp(b) [19]. The transfusion of incomp atible red blood cells improved the anemia and allowed the exploratory laparotomy to take place. A protocol was then developed based on this case administering pretransfusion IVIG in high doses for patients for whom no compatible blood (non-ABO) is available.