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Hemolysis From Intravenous Immunoglobulin in Obese Patients With Kawasaki Disease
Objective: We assessed the risk of IVIG-associated hemolytic anemia in patients with acute Kawasaki disease (KD) and evaluated the risk of weight-based dosing in our obese patients. Methods: IVIG-associated hemolytic anemia was assessed in acute KD patients treated with IVIG at Rady Children's...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146618/ https://www.ncbi.nlm.nih.gov/pubmed/32318529 http://dx.doi.org/10.3389/fped.2020.00146 |
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author | Van Anh, Khanh-Van Y. Shah, Saloni Tremoulet, Adriana H. |
author_facet | Van Anh, Khanh-Van Y. Shah, Saloni Tremoulet, Adriana H. |
author_sort | Van Anh, Khanh-Van Y. |
collection | PubMed |
description | Objective: We assessed the risk of IVIG-associated hemolytic anemia in patients with acute Kawasaki disease (KD) and evaluated the risk of weight-based dosing in our obese patients. Methods: IVIG-associated hemolytic anemia was assessed in acute KD patients treated with IVIG at Rady Children's Hospital-San Diego. Patients in whom hemolytic anemia was suspected had a decrease in z-score of their hemoglobin (zHgb) at least two standard deviations below the cohort's mean change in zHgb from baseline to 2 weeks post-IVIG treatment. These patients were further evaluated for spherocytosis, blood type, need for transfusion, red cell distribution width, reticulocytosis, and direct Coombs test. Body mass index was calculated. Results: Of the 30 IVIG-resistant KD patients who received a second dose of IVIG, 2 (6.7%) developed hemolytic anemia after a total of 4 g/kg of IVIG dosed on actual body weight, or a mean of 4.6 g/kg of IVIG based on lean body mass. Compared to 496 non-obese KD patients who received a single dose of IVIG with no cases of hemolytic anemia, two (5.6%) of 36 obese KD patients developed hemolytic anemia after a single dose of IVIG (2 g/kg) dosed on actual body weight, or a mean of 2.7 g/kg IVIG based on lean body mass. Conclusions: In addition to following patients carefully for hemolytic anemia after a second dose of IVIG, physicians should consider IVIG dosing based on lean body mass for obese patients. |
format | Online Article Text |
id | pubmed-7146618 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-71466182020-04-21 Hemolysis From Intravenous Immunoglobulin in Obese Patients With Kawasaki Disease Van Anh, Khanh-Van Y. Shah, Saloni Tremoulet, Adriana H. Front Pediatr Pediatrics Objective: We assessed the risk of IVIG-associated hemolytic anemia in patients with acute Kawasaki disease (KD) and evaluated the risk of weight-based dosing in our obese patients. Methods: IVIG-associated hemolytic anemia was assessed in acute KD patients treated with IVIG at Rady Children's Hospital-San Diego. Patients in whom hemolytic anemia was suspected had a decrease in z-score of their hemoglobin (zHgb) at least two standard deviations below the cohort's mean change in zHgb from baseline to 2 weeks post-IVIG treatment. These patients were further evaluated for spherocytosis, blood type, need for transfusion, red cell distribution width, reticulocytosis, and direct Coombs test. Body mass index was calculated. Results: Of the 30 IVIG-resistant KD patients who received a second dose of IVIG, 2 (6.7%) developed hemolytic anemia after a total of 4 g/kg of IVIG dosed on actual body weight, or a mean of 4.6 g/kg of IVIG based on lean body mass. Compared to 496 non-obese KD patients who received a single dose of IVIG with no cases of hemolytic anemia, two (5.6%) of 36 obese KD patients developed hemolytic anemia after a single dose of IVIG (2 g/kg) dosed on actual body weight, or a mean of 2.7 g/kg IVIG based on lean body mass. Conclusions: In addition to following patients carefully for hemolytic anemia after a second dose of IVIG, physicians should consider IVIG dosing based on lean body mass for obese patients. Frontiers Media S.A. 2020-04-03 /pmc/articles/PMC7146618/ /pubmed/32318529 http://dx.doi.org/10.3389/fped.2020.00146 Text en Copyright © 2020 Van Anh, Shah and Tremoulet. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Pediatrics Van Anh, Khanh-Van Y. Shah, Saloni Tremoulet, Adriana H. Hemolysis From Intravenous Immunoglobulin in Obese Patients With Kawasaki Disease |
title | Hemolysis From Intravenous Immunoglobulin in Obese Patients With Kawasaki Disease |
title_full | Hemolysis From Intravenous Immunoglobulin in Obese Patients With Kawasaki Disease |
title_fullStr | Hemolysis From Intravenous Immunoglobulin in Obese Patients With Kawasaki Disease |
title_full_unstemmed | Hemolysis From Intravenous Immunoglobulin in Obese Patients With Kawasaki Disease |
title_short | Hemolysis From Intravenous Immunoglobulin in Obese Patients With Kawasaki Disease |
title_sort | hemolysis from intravenous immunoglobulin in obese patients with kawasaki disease |
topic | Pediatrics |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146618/ https://www.ncbi.nlm.nih.gov/pubmed/32318529 http://dx.doi.org/10.3389/fped.2020.00146 |
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