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

BACKGROUND

As an initial therapy for Kawasaki disease, high-dose intravenous immunoglobulin (IVIG) is recommended. It is known that intravenous immunoglobulins are associated with hemolytic anemia. However, little is known about hemolytic anemia in Kawasaki disease (KD) patients treated with IVIG. This study was designed to investigate the incidence of hemolytic anemia and factors associated with the development of hemolysis in KD patients treated with IVIG.

METHODS

We performed a 3-year single-center prospective study enrolling 105 KD patients treated with IVIG from January 2021 to May 2024 at Chungnam National University Hospital. Clinical characteristics and laboratory data were collected and analyzed. Hemolytic anemia was defined as a drop in hemoglobin levels or worsening of anemia after IVIG infusion greater than or equal to 2 g/dL with supporting biochemical studies.

RESULTS

Fifteen percent of KD patients (16/105) developed hemolytic anemia post-IVIG. Increased IVIG dose, prolonged duration of fever, high pre- and post-IVIG white blood cell counts, non-O blood groups, NT-ProBNP, and refractory KD were significantly associated with the hemolysis group (p < 0.05). However, erythrocyte sedimentation rate (ESR), C-reactive protein, and iron deficiency anemia parameters were not significant between the two groups.

CONCLUSION

This study suggests that a non-O blood group, a higher cumulative IVIG dose, elevated NT-ProBNP levels, and increased white blood cell counts may be associated with an increased risk of hemolysis following IVIG therapy. These findings are hypothesis-generating and support the need for closer monitoring and further investigation in larger, controlled studies.