Hemolytic anemia post high-dose IVIG in Kawasaki disease: Impact of inflammation and iron status on outcomes.

The incidence of hemolytic anemia post-IVIG in Kawasaki disease patients was 15%.

• 16 out of 105 KD patients developed hemolytic anemia after IVIG infusion.
• This was a 3-year single-center prospective study conducted from January 2021 to May 2024 at Chungnam National University Hospital.
• Hemolytic anemia was defined as a drop in hemoglobin levels or worsening of anemia after IVIG infusion of greater than or equal to 2 g/dL with supporting biochemical studies.

Non-O blood groups were significantly associated with the development of hemolytic anemia post-IVIG in Kawasaki disease patients.

• Non-O blood group was significantly more prevalent in the hemolysis group compared to the non-hemolysis group (p < 0.05).
• This association is consistent with the known mechanism by which IVIG contains isohemagglutinins (anti-A and anti-B antibodies) that can cause hemolysis in non-O blood group recipients.
• Non-O blood group was identified as one of the key factors associated with increased hemolysis risk.

Higher cumulative IVIG dose was significantly associated with hemolytic anemia development in KD patients.

• Increased IVIG dose was significantly associated with the hemolysis group (p < 0.05).
• The study population received high-dose IVIG as the initial recommended therapy for Kawasaki disease.
• IVIG dose was identified as one of the primary factors associated with hemolysis risk.

Elevated NT-ProBNP levels were significantly associated with hemolytic anemia following IVIG therapy in KD patients.

• NT-ProBNP was significantly higher in the hemolysis group compared to the non-hemolysis group (p < 0.05).
• Refractory KD was also significantly associated with the hemolysis group (p < 0.05), and NT-ProBNP elevation may reflect more severe disease.
• NT-ProBNP was identified as one of the key factors associated with increased risk of post-IVIG hemolysis.

Elevated white blood cell counts both before and after IVIG administration were significantly associated with hemolytic anemia.

• High pre- and post-IVIG white blood cell counts were significantly associated with the hemolysis group (p < 0.05).
• Prolonged duration of fever was also significantly associated with the hemolysis group (p < 0.05).
• These findings suggest that a higher inflammatory burden may predispose KD patients to hemolysis following IVIG.

Erythrocyte sedimentation rate, C-reactive protein, and iron deficiency anemia parameters were not significantly different between the hemolysis and non-hemolysis groups.

• ESR, CRP, and iron deficiency anemia parameters were not significant between the two groups (p ≥ 0.05).
• Despite being common markers of inflammation and anemia in KD, these parameters did not differentiate patients who developed hemolysis from those who did not.
• The lack of association with iron deficiency anemia parameters suggests that pre-existing iron status did not significantly influence hemolysis outcomes in this cohort.