Korean Journal of Veterinary Research (대한수의학회지)

The Korean Society of Veterinary Science (대한수의학회)
권호 표지
DOI QR코드

DOI QR Code

Immune-mediated hemolysis after administration of human intravenous immunoglobulin in a dog: a case report

  • Minji Kim (College of Veterinary Medicine, Gyeongsang National University) ;
  • Youngju Kim (College of Veterinary Medicine, Gyeongsang National University) ;
  • Hyeona Bae (College of Veterinary Medicine, Gyeongsang National University) ;
  • Rankyung Jung (College of Veterinary Medicine, Gyeongsang National University) ;
  • Minjeong Kang (College of Veterinary Medicine, Gyeongsang National University) ;
  • Sumin Cha (College of Veterinary Medicine, Gyeongsang National University) ;
  • Kyu-Woan Cho (College of Veterinary Medicine, Gyeongsang National University) ;
  • Dong-In Jung (College of Veterinary Medicine, Gyeongsang National University) ;
  • DoHyeon Yu (College of Veterinary Medicine, Gyeongsang National University)
  • Received : 2023.06.29
  • Accepted : 2023.09.06
  • Published : 2023.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

A 10-year-old spayed female Maltese presented with purpura and hematemesis. Initial laboratory evaluation revealed immune-mediated thrombocytopenia, but evidence of hemolytic anemia was not identified. Three milligrams of human intravenous immunoglobulin (hIVIG) was administered for 3 hours following prednisolone and mycophenolate mofetil. A pale mucous membrane was identified, and the packed cell volume decreased by 3%. Blood film examination revealed significant spherocytosis with auto-agglutination. Blood transfusions and immunosuppression were continued for 4 days, and hIVIG was discontinued. This report describes a case of increased immune-mediated hemolysis after hIVIG administration, possibly due to new-onset immune-mediated hemolytic anemia or enhanced immunogenicity.

Keywords

Acknowledgement

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (2020R1C1C1008675).

References

  1. Kazatchkine MD, Kaveri SV. Immunomodulation of autoimmune and inflammatory diseases with intravenous immune globulin. N Engl J Med 2001;345:747-755. https://doi.org/10.1056/NEJMra993360
  2. Orange JS, Hossny EM, Weiler CR, Ballow M, Berger M, Bonilla FA, Buckley R, Chinen J, El-Gamal Y, Mazer BD, Nelson RP Jr, Patel DD, Secord E, Sorensen RU, Wasserman RL, Cunningham-Rundles C; Primary Immunodeficiency Committee of the American Academy of Allergy, Asthma and Immunology. Use of intravenous immunoglobulin in human disease: a review of evidence by members of the Primary Immunodeficiency Committee of the American Academy of Allergy, Asthma and Immunology. J Allergy Clin Immunol 2006;117(4 Suppl):S525-S553. https://doi.org/10.1016/j.jaci.2006.01.015
  3. Spurlock NK, Prittie JE. A review of current indications, adverse effects, and administration recommendations for intravenous immunoglobulin. J Vet Emerg Crit Care (San Antonio) 2011;21:471-483. https://doi.org/10.1111/j.1476-4431.2011.00676.x
  4. Kahwaji J, Barker E, Pepkowitz S, Klapper E, Villicana R, Peng A, Chang R, Jordan SC, Vo AA. Acute hemolysis after high-dose intravenous immunoglobulin therapy in highly HLA sensitized patients. Clin J Am Soc Nephrol 2009;4:1993-1997. https://doi.org/10.2215/CJN.04540709
  5. Koo Y, Yun T, Chae Y, Lee D, Choi D, Oh J, Kim J, Kim H, Yang MP, Kang BT. Suspected human intravenous immunoglobulin-induced acute haemolytic anaemia in a dog. J Small Anim Pract 2022;63:482-485. https://doi.org/10.1111/jsap.13449
  6. Garden OA, Kidd L, Mexas AM, Chang YM, Jeffery U, Blois SL, Fogle JE, MacNeill AL, Lubas G, Birkenheuer A, Buoncompagni S, Dandrieux JRS, Di Loria A, Fellman CL, Glanemann B, Goggs R, Granick JL, LeVine DN, Sharp CR, Smith-Carr S, Swann JW, Szladovits B. ACVIM consensus statement on the diagnosis of immune-mediated hemolytic anemia in dogs and cats. J Vet Intern Med 2019;33:313-334. https://doi.org/10.1111/jvim.15441
  7. Euler CC, Raj K, Mizukami K, Murray L, Chen CY, Mackin A, Giger U. Xenotransfusion of anemic cats with blood compatibility issues: pre- and posttransfusion laboratory diagnostic and crossmatching studies. Vet Clin Pathol 2016;45:244-253. https://doi.org/10.1111/vcp.12366
  8. Le Gal A, Thomas EK, Humm KR. Xenotransfusion of canine blood to cats: a review of 49 cases and their outcome. J Small Anim Pract 2020;61:156-162. https://doi.org/10.1111/jsap.13096
  9. Edwards TH, Wienandt NA, Baxter RL, Mays EL, Gay SD, Cap AP. In vitro compatibility of canine and human blood: a pilot study. J Spec Oper Med 2019;19:95-99. https://doi.org/10.55460/6EAP-6E9G
  10. Taylor E, Vu D, Legare C, Keene D. Intravenous immune globulin-related hemolysis: comparing two different methods for case assessment. Transfusion 2015;55 Suppl 2:S23-S27. https://doi.org/10.1111/trf.13096
  11. Quigley KA, Chelack BJ, Haines DM, Jackson ML. Application of a direct flow cytometric erythrocyte immunofluorescence assay in dogs with immune-mediated hemolytic anemia and comparison to the direct antiglobulin test. J Vet Diagn Invest 2001;13:297-300. https://doi.org/10.1177/104063870101300403
  12. Overmann JA, Sharkey LC, Weiss DJ, Borjesson DL. Performance of 2 microtiter canine Coombs' tests. Vet Clin Pathol 2007;36:179-183. https://doi.org/10.1111/j.1939-165X.2007.tb00205.x
  13. Wardrop KJ. Coombs' testing and its diagnostic significance in dogs and cats. Vet Clin North Am Small Anim Pract 2012;42:43-51. https://doi.org/10.1016/j.cvsm.2011.09.005
  14. Jones DR, Gruffydd-Jones TJ, Stokes CR, Bourne FJ. Investigation into factors influencing performance of the canine antiglobulin test. Res Vet Sci 1990;48:53-58. https://doi.org/10.1016/S0034-5288(18)31509-1
  15. Sun PL, Jeffery U. Effect of dilution of canine blood samples on the specificity of saline agglutination tests for immune-mediated hemolysis. J Vet Intern Med 2020;34:2374-2383. https://doi.org/10.1111/jvim.15945