{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T07:39:46Z","timestamp":1773733186763,"version":"3.50.1"},"reference-count":30,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"vor","delay-in-days":74,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatrics International"],"published-print":{"date-parts":[[2026,1]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n As an initial therapy for Kawasaki disease, high\u2010dose 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.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We performed a 3\u2010year single\u2010center 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\u2009g\/dL with supporting biochemical studies.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Fifteen percent of KD patients (16\/105) developed hemolytic anemia post\u2010IVIG. Increased IVIG dose, prolonged duration of fever, high pre\u2010 and post\u2010IVIG white blood cell counts, non\u2010O blood groups, NT\u2010ProBNP, and refractory KD were significantly associated with the hemolysis group (\n p<\/jats:italic>\n \u2009<\u20090.05). However, erythrocyte sedimentation rate (ESR), C\u2010reactive protein, and iron deficiency anemia parameters were not significant between the two groups.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n This study suggests that a non\u2010O blood group, a higher cumulative IVIG dose, elevated NT\u2010ProBNP levels, and increased white blood cell counts may be associated with an increased risk of hemolysis following IVIG therapy. These findings are hypothesis\u2010generating and support the need for closer monitoring and further investigation in larger, controlled studies.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/ped.70370","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T05:16:39Z","timestamp":1773724599000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hemolytic anemia post high\u2010dose\n IVIG<\/scp>\n in Kawasaki disease: Impact of inflammation and iron status on outcomes"],"prefix":"10.1111","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1069-1636","authenticated-orcid":false,"given":"Mucheleng\u2019anga","family":"Lusungu","sequence":"first","affiliation":[{"name":"Department of Pediatrics Chungnam National University Hospital, College of Medicine, Chungnam National University Daejeon Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4181-9683","authenticated-orcid":false,"given":"Youna","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Chungnam National University Hospital Sejong Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0937-508X","authenticated-orcid":false,"given":"Bae Eun","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Chungnam National University Hospital, College of Medicine, Chungnam National University Daejeon Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9634-3950","authenticated-orcid":false,"given":"Choi Ah","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Chungnam National University Hospital, College of Medicine, Chungnam National University Daejeon Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6837-7475","authenticated-orcid":false,"given":"Geena","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Chungnam National University Hospital Sejong Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8815-333X","authenticated-orcid":false,"given":"Yeon Jung","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Chungnam National University Hospital, College of Medicine, Chungnam National University Daejeon Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4925-8240","authenticated-orcid":false,"given":"Hong Ryang","family":"Kil","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Chungnam National University Hospital, College of Medicine, Chungnam National University Daejeon Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"issue":"4","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/j.jsps.2014.11.003","article-title":"Kawasaki disease with Glucose\u20106\u2010phosphate dehydrogenase deficiency, case report","volume":"23","author":"Obeidat HR","year":"2015","journal-title":"Saudi Pharm J"},{"issue":"17","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"e943","DOI":"10.1161\/CIR.0000000000000484","article-title":"Diagnosis, treatment, and long\u2010term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association","volume":"135","author":"McCrindle 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YH","year":"2016","journal-title":"Int J Mol Sci"},{"key":"e_1_2_11_7_1","doi-asserted-by":"crossref","unstructured":"KimHJ ChoiEH KilHR.Effect of hepcidin and iron deficiency anemia on clinical outcome in patients with Kawasaki disease.2019.https:\/\/www.researchsquare.com\/article\/rs\u20109821\/v1","DOI":"10.21203\/rs.2.19208\/v1"},{"key":"e_1_2_11_8_1","unstructured":"DisK.Refractory Kawasaki Disease in South Korea.https:\/\/doi.org\/10.59492\/kd.1.1.e7"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000484"},{"key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"430","DOI":"10.3345\/cep.2021.01459","article-title":"Diagnosis of coronary artery abnormalities in Kawasaki disease: recent guidelines and z score systems","volume":"65","author":"Kim SH","year":"2022","journal-title":"Clin Exp Pediatr"},{"issue":"1","key":"e_1_2_11_11_1","doi-asserted-by":"crossref","DOI":"10.1186\/s12887-024-04546-z","article-title":"Hemolytic anemia 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how does it occur?","volume":"3","author":"Watanabe T","year":"2013","journal-title":"J Pediatr Biochem"},{"issue":"22","key":"e_1_2_11_27_1","doi-asserted-by":"crossref","first-page":"2606","DOI":"10.1161\/CIRCULATIONAHA.105.592865","article-title":"Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease","volume":"113","author":"Kobayashi T","year":"2006","journal-title":"Circulation"},{"issue":"2","key":"e_1_2_11_28_1","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.jpeds.2006.03.050","article-title":"Prediction of resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease","volume":"149","author":"Egami K","year":"2006","journal-title":"J Pediatr"},{"issue":"2","key":"e_1_2_11_29_1","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1007\/s00431-006-0223-z","article-title":"Prediction of non\u2010responsiveness to standard high\u2010dose gamma\u2010globulin therapy in patients with acute Kawasaki 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