Acute renal failure after intravenous anti-D immune globulin in an adult with immune thrombocytopenic purpura.
Author(s): Chun NS, Savani B, Seder RH, Taplin ME
Affiliation(s): Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts 01655, USA. ChunN@ummhc.org
Publication date & source: 2003-12, Am J Hematol., 74(4):276-9.
Publication type: Case Reports
Intravenous anti-D immune globulin (anti-D IGIV) is indicated for the treatment of immune thrombocytopenic purpura (ITP) in nonsplenectomized patients who are Rh(D)-positive. Recent reports have described episodes of intravascular hemolysis (IVH) and acute renal failure (ARF) after anti-D IGIV. We report the first adult patient with ITP who required and received dialysis after IVH and ARF complicating treatment with anti-D IGIV. Whether the transfusion of 2 units of Rh(D)-positive red cells, indicated for the resulting anemia, exacerbated the IVH and renal failure is unclear. Three weeks after the administration of anti-D IGIV (13 days after two hemodialysis treatments), the patient's renal function had returned to normal. This case highlights the infrequent but potentially serious side effects of anti-D IGIV and the need to monitor a patient's renal function closely if there is evidence of IVH after infusion of anti-D IGIV. If red cell transfusion is indicated, we recommend the use of Rh(D)-negative red cell products. Copyright 2003 Wiley-Liss, Inc.