Abstract

An expected side effect of intravenous anti-D therapy is a mild, transient hemolysis due to splenic destruction of anti-D sensitized Rh+ red cells. Although the majority of patients show a fall in hemoglobin of only 1 -3 g/dl, a few patients have an unexpectedly large degree of hemolysis leading to a larger fall in hemoglobin. Additionally some patients have been reported to have had intravascular hemolysis (IVH), in some cases leading to changes in renal function. We report the 40 cases of hemolytic complications thus far reported to the manufacturer, including unexpectedly large degrees of hemoiysis (fall in hemoglobin 3.0 g/dl), and cases of IVH (demonstrated by hematuria or free plasma hemoglobin) with and without changes in renal function or the need for dialysis. Of these, 19 had a hemoglobin fall 3.0 g/dl, of whom 14 had a fall in hemoglobin 4.0 g/dl, with respectively 7 and 6 of these receiving transfusions. Of the 37 patients with evidence of intravascular hemolysis, 12 showed changes in renal function, 4 of whom had renal failure requiring hemodialysis. 3 of these had eventual complete resolution of renal function, while the other died of progressive leukemia while on dialysis. Additionally, hyperbilirubinemia (total bilirubin 1.5 mg/dl) was documented in 19 (51%) of the IVH cases and 11 and 8 (38% and 57%) of the cases of hemoglobin fall 3.0 and 4.0 g/dl respectively, and one of these progressed to liver failure. Although 4 of the 40 patients expired, in only one case was hemolysis thought to be a contributing factor. Because of small numbers and missing data in these reports, multivariate analysis could only suggest some of the risk factors for hemolytic complications. Efficacy, defined as a platelet rise 30K/mm\ was 58% and 64% in the cases of hemoglobin fall 3.0 and 4.0 g/dl respectively, but only 38% in the IVH group, however definitive correlation between hemolytic complications and efficacy was limited by incomplete data. More complete reporting will be needed to define better the risk factors and determine the actual incidence of hemolytic complications of anti-D therapy.

Original languageEnglish (US)
JournalBlood
Volume96
Issue number11 PART I
Publication statusPublished - Dec 1 2000

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All Science Journal Classification (ASJC) codes

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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