Occurrence of hemolytic anemia in patients with GBS treated with high-dose IVIg

OBJECTIVE: We describe an underrecognized side effect of high-dose IV immunoglobulin (IVIg), hemolytic anemia. BACKGROUND: There are no established guidelines on treating patients with Guillain-Barré syndrome (GBS) who relapse or do not improve after a standard course of treatment (IVIg or plasma exchange). Some centers will opt for a second course of the initial treatment. There is an ongoing trial of a second course of IVIg in patients with severe GBS. METHODS: We retrospectively reviewed 4 patients with severe GBS who received high-dose IVIg. One patient inadvertently received a high dose of IVIg for Miller Fisher syndrome. All patients received a total of at least 2 courses of the standard dose of IVIg (total >4 g/kg). We review their clinical course and side effects. RESULTS: All patients with non-O blood types developed clinically significant hemolytic anemia requiring blood transfusion. CONCLUSION: Hemolytic anemia may limit doses of IVIg for treatment of severe GBS in patients with non-O blood types.