{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T01:05:43Z","timestamp":1792717543965,"version":"4.5.0"},"reference-count":42,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2013,7,5]],"date-time":"2013-07-05T00:00:00Z","timestamp":1372982400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2014,3]]},"abstract":"Background<\/jats:title>Hemolysis may follow intravenous immunoglobulin (IVIG<\/jats:styled-content>), with product, dosing, and host factors contributing. The importance of recipient features remains unclear.<\/jats:p><\/jats:sec>Case Report<\/jats:title>A 52\u2010year\u2010old obese woman, 10 years after ABO<\/jats:styled-content>\u2010mismatched (recipient O<\/jats:styled-content>, donor A<\/jats:styled-content>) marrow transplantation, presented with immune thrombocytopenia (ITP<\/jats:styled-content>). IVIG<\/jats:styled-content> at 100\u2009g\/day\u2009\u00d7\u20092 days was followed by hemoglobinuria and angina and dyspnea, with frank hemoglobinemia and anemia (hemoglobin 12.9 to 8.4 over 24\u2009hr, to a nadir of 6.9\u2009g\/dL<\/jats:styled-content>).<\/jats:p><\/jats:sec>Study Design and Methods<\/jats:title>Serologic methods established ABO<\/jats:styled-content>, A<\/jats:styled-content>1, L<\/jats:styled-content>ewis, and S<\/jats:styled-content>ecretor type, while monocyte monolayer assay (MMA<\/jats:styled-content>) examined erythrophagocytosis with control or patient monocytes, and the implicated IVIG<\/jats:styled-content> lot to opsonize control (group A<\/jats:styled-content>1, A<\/jats:styled-content>2, B<\/jats:styled-content>, O<\/jats:styled-content>) or patient red blood cells (RBCs). Baseline, hemolytic, and convalescent markers (including cytokines) were assessed.<\/jats:p><\/jats:sec>Results<\/jats:title>Passive anti\u2010A<\/jats:styled-content> was identified on reverse type and eluted from sensitized RBCs (immunoglobulin\u2009G<\/jats:styled-content> 1+, C<\/jats:styled-content>3d\u2013). L<\/jats:styled-content>e(a\u2013b+) typing and saliva confirmed H S<\/jats:styled-content>ecretor status. MMA<\/jats:styled-content> revealed significant activity between patient RBCs, monocytes, and IVIG<\/jats:styled-content>. However, normal A<\/jats:styled-content>1 cells opsonized with IVIG<\/jats:styled-content> were not significantly phagocytosed by either normal or patient monocytes. Proinflammatory markers were significantly elevated before and after IVIG<\/jats:styled-content>.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Synergizing host factors (including obesity\u2010unadjusted dosing and existing inflammation) marked this severe post\u2010IVIG<\/jats:styled-content> hemolytic crisis. Group A<\/jats:styled-content> antigen restriction to myeloid tissues, with H S<\/jats:styled-content>ecretor phenotype, may have contributed, rendering this bone marrow transplant chimera vulnerable to anti\u2010A<\/jats:styled-content> in a manner analogous to the idiosyncratic effect of therapeutic anti\u2010D<\/jats:styled-content> in certain D<\/jats:styled-content>+ ITP<\/jats:styled-content> recipients. However, MMA<\/jats:styled-content> suggested a macrophage activation state as contributory, perhaps precipitated by existing inflammation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.12329","type":"journal-article","created":{"date-parts":[[2013,7,5]],"date-time":"2013-07-05T12:10:16Z","timestamp":1373026216000},"page":"681-690","source":"Crossref","is-referenced-by-count":31,"title":["Acute hemolysis after intravenous immunoglobulin amid host factors of ABO<\/scp>\u2010mismatched bone marrow transplantation, inflammation, and activated mononuclear phagocytes"],"prefix":"10.1111","volume":"54","author":[{"given":"Fotios V.","family":"Michelis","sequence":"first","affiliation":[{"name":"Blood and Marrow Transplant Program Princess Margaret Hospital University Health Network Toronto Ontario Canada"},{"name":"Research & Development Canadian Blood Services Toronto Ontario Canada"},{"name":"Transfusion Medicine Laboratory University Health Network University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald R.","family":"Branch","sequence":"additional","affiliation":[{"name":"Blood and Marrow Transplant Program Princess Margaret Hospital University Health Network Toronto Ontario Canada"},{"name":"Research & Development Canadian Blood Services Toronto Ontario Canada"},{"name":"Transfusion Medicine Laboratory University Health Network University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iain","family":"Scovell","sequence":"additional","affiliation":[{"name":"Blood and Marrow Transplant Program Princess Margaret Hospital University Health Network Toronto Ontario Canada"},{"name":"Research & Development Canadian Blood Services Toronto Ontario Canada"},{"name":"Transfusion Medicine Laboratory University Health Network University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evgenia","family":"Bloch","sequence":"additional","affiliation":[{"name":"Blood and Marrow Transplant Program Princess Margaret Hospital University Health Network Toronto Ontario Canada"},{"name":"Research & Development Canadian Blood Services Toronto Ontario Canada"},{"name":"Transfusion Medicine Laboratory University Health Network University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Pendergrast","sequence":"additional","affiliation":[{"name":"Blood and Marrow Transplant Program Princess Margaret Hospital University Health Network Toronto Ontario Canada"},{"name":"Research & Development Canadian Blood Services Toronto Ontario Canada"},{"name":"Transfusion Medicine Laboratory University Health Network University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey H.","family":"Lipton","sequence":"additional","affiliation":[{"name":"Blood and Marrow Transplant Program Princess Margaret Hospital University Health Network Toronto Ontario Canada"},{"name":"Research & Development Canadian Blood Services Toronto Ontario Canada"},{"name":"Transfusion Medicine Laboratory University Health Network University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine M.","family":"Cserti\u2010Gazdewich","sequence":"additional","affiliation":[{"name":"Blood and Marrow Transplant Program Princess Margaret Hospital University Health Network Toronto Ontario Canada"},{"name":"Research & Development Canadian Blood Services Toronto Ontario Canada"},{"name":"Transfusion Medicine Laboratory University Health Network University of Toronto Toronto Ontario 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