An intravenous immunoglobulin product may contain antibodies to ABO antigens (anti-A and anti-B). These can cause hemolysis in a patient with a suitable ABO type if the antibodies are not removed during product preparation.


Mechanisms: Some patients in the pool may have high titers of ABO antibodies.


Some manufacturers remove these antibodies by affinity chromatography during product preparation.


Patient subject to hemolysis: ABO types A, B or AB



(1) unexplained fall in hemoglobin

(2) pink serum after infusion

(3) jaundice or hyperbilirubinemia

(4) fall in serum haptoglobin

(5) positive antiglobulin test


The diagnosis can be confirmed by reacting the immune globulin preparation against reagent A or B cells. Since the potential antibody may be IgG a direct antiglobulin test (DAT) step should be included.


Differential diagnosis:

(1) warm or cold autoimmune hemolytic disease

(2) vasculitis associated with the underlying disease


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