Kohan et al developed a protocol for administration of high dose intravenous immunoglobulin (IVIG) in a patient who has received a transfusion of non-ABO incompatible blood. This can help reduce hemolysis following the transfusion and allow the patient to undergo lifesaving therapy. The authors are from Hospital de Clinicas "Jose de San Martin" and the Universidad de Buenos Aires in Argentina.
The protocol can be used for patients with alloantibodies and/or autoantibodies.
Protocol:
(1) The dose for intravenous immunoglobulin was 400 mg per kg body weight.
(2) A single infusion is given just before or within 24 hours of the incompatible transfusion.
(3) Corticosteroids may also be given (prednisone 80 mg, hydrocortisone 500 mg, or methylprednisolone 500 mg).
(4) Monitor the patient for signs of hemolysis.
Limitations:
(1) The protocol would not work for an ABO incompatible blood transfusion (almost always results in immediate hemolysis.
(2) The method may not be effective with non-ABO antibodies if complement is bound.
(3) A higher dose of IVIG may be needed if more than one unit of incompatible blood was transfused.
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