Association of hemolysis with high dose intravenous immunoglobulin therapy in pediatric patients: An open-label prospective trial.

Immunoglobulin therapy can be used to treat a wide variety of diseases. However, intravenous immunoglobin products can cause several adverse reactions, including hemolysis. The objective of this study was to determine the extent of anemia and hemolysis after high dose intravenous immunoglobin (2g/kg) and its relationship to the ABO blood type system and hemolytic anemia blood parameters in pediatric patients. Incidence of 'Intravenous immunoglobulin related hemolysis' was %19 (6/31) after high dose intravenous immunoglobulin therapy. The blood parameters were measured before IVIG infusion (1-24h before infusion) and 3-10 days after the first day of infusion. In terms of decrease in Hb levels; decline of <1g/dL was detected in 25 patients (80.6%), ≥1g/dL in 2 patients (6.5%) and >2g/dL (severe hemolysis) in 4 patients (12.9%) after infusion. The decrease in hemoglobin, haptoglobin levels, the increase of reticulocyte count or direct bilirubin were statistically significant after infusion. Five of 6 hemolysis patients had non-O blood group, however statistically significant difference was not noted between these two groups. Also, intravenous immunoglobulin-related hemolysis was determined significantly higher in female than male patients. CONCLUSION: Mild to moderate hemolysis may be undetected after infusion and the true incidence of such reactions is difficult to document without careful clinical and laboratory follow-up. A careful risk assessment analysis should be performed before intravenous immunoglobulin infusion.

The decrease in erythrocyte sedimentation rate related to general anesthesia.

The aim of this study was to investigate whether general anesthetic agents change erythrocyte sedimentation rate (ESR) affecting erythrocytes' shape and membrane structure in routine clinical dose manner. Forty patients (23 female and 17 male) undergoing elective surgery were included to the study. Blood samples were obtained just before induction of the anesthesia and 10 minutes after endotracheal intubation. The ESR was measured using Test-1 ESR analyzer. ESR values of the second blood samples were significantly lower than the first values (p<0.001). At the beginning, the ESR was 18.1+/-11.5 mm/h, and then it decreased to 13.1+/-9.3 at 10th minutes. Our results indicated that anesthetic agents affected the ESR. No increase was observed in the second ESR values which were equal to, or less than the first values. General anesthesia may lead to this decrease changing electrolyte balance of erythrocyte, affecting ligands of agglomerins in membrane directly and indirectly, or changing discoid shape of erythrocyte.

The effects of the non-volatile anaesthetic agents, propofol and thiopental, on erythrocyte sedimentation rate.

OBJECTIVES: The reduction of erythrocyte sedimentation rate (ESR) induced by general anaesthesia was demonstrated in our previous study. The purpose of the present study was to investigate whether the type of induction agent (propofol or thiopental) used for general anaesthesia had any effects on ESR. METHODS: Sixty-four patients (ASA Physical Status Classification, I-II) scheduled for elective surgery under general anaesthesia were randomly assigned into two groups. In Group I, propofol and in Group II, thiopental were used as induction agents. Two blood samples were obtained before induction and 10 minutes after endotracheal intubation for ESR measurements. RESULTS: The ESR values of the second samples from both groups were significantly lower than the values of the first samples, but there were no statistically significant differences in ESR values between the values of the two groups. CONCLUSION: The results showed that general anaesthesia decreased ESR values regardless of the type of agents being used for induction of anaesthesia. The reason might be related to other drugs used in both groups, or to a common effector mechanism of the two induction agents. The underlying mechanism needs to be investigated.