{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T19:06:25Z","timestamp":1770750385914,"version":"3.50.0"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,4,11]],"date-time":"2023-04-11T00:00:00Z","timestamp":1681171200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>This is the first case report on two children presenting with immediate and severe hemolytic anemia following the administration of high-dose intravenous immunoglobulins (IVIGs) in the context of pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). Hemolytic anemia was described as a significant decrease in hemoglobin and an increase in lactate dehydrogenase after the second administration of high-dose IVIGs was performed. Both patients were found to have AB blood group. One of our patients showed massive pallor, weakness, and inability to walk in association with hemolysis. However, in both cases, the anemia was self-limiting and transfusion of red blood cells was not required: both patients recovered without persistent impact. Nonetheless, we aim to draw attention to this widely unknown adverse effect of IVIG, especially in the context of PIMS-TS. We suggest determining the patient\u2019s blood group prior to high-dose IVIG infusion and replacing the second IVIG through high-dose steroids or anticytokine therapy. Using IVIGs containing lower titers of specifically anti-A or anti-B antibodies to avoid isoagglutinin-caused hemolytic anemia is desirable; however, the information is not routinely available.<\/jats:p>","DOI":"10.3389\/fped.2023.1144914","type":"journal-article","created":{"date-parts":[[2023,4,11]],"date-time":"2023-04-11T05:49:13Z","timestamp":1681192153000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Hemolytic anemia following intravenous immunoglobulins in children with PIMS-TS: Two case reports"],"prefix":"10.3389","volume":"11","author":[{"given":"E.","family":"Sedlin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Lau","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H.","family":"von Bernuth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Kallinich","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B.","family":"Mayer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,4,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e6","DOI":"10.1097\/INF.0000000000003393","article-title":"An update on multisystem inflammatory syndrome in children related to SARS-CoV-2","volume":"41","author":"Dionne","year":"2022","journal-title":"Pediatr Infect Dis J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/s12969-021-00511-7","article-title":"Defining Kawasaki disease and pediatric inflammatory multisystem syndrome-temporarily associated to SARS-CoV2 infection during SARS-CoV2 epidemic in Italy: results from a national, multicenter survey","volume":"19","author":"Cattalini","year":"2021","journal-title":"Pediatr Rheumatol Online J"},{"key":"B3","doi-asserted-by":"publisher","first-page":"4358","DOI":"10.1002\/jmv.26951","article-title":"The inflammatory markers of multisystem inflammatory syndrome in children (MIS-C) and adolescents associated with COVID-19: a meta-analysis","volume":"93","author":"Zhao","year":"2021","journal-title":"J Med Virol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"632890","DOI":"10.3389\/fimmu.2021.632890","article-title":"Phenotype, susceptibility, autoimmunity, and immunotherapy between Kawasaki disease and coronavirus disease-19 associated multisystem inflammatory syndrome in children","volume":"12","author":"Chen","year":"2021","journal-title":"Front Immunol"},{"key":"B5","year":""},{"key":"B6","doi-asserted-by":"publisher","first-page":"3416","DOI":"10.1182\/bloodadvances.2020002253","article-title":"Treatment-associated hemolysis in Kawasaki disease: association with blood-group antibody titers in IVIG products","volume":"4","author":"Bruggeman","year":"2020","journal-title":"Blood Adv"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e100","DOI":"10.1097\/MPH.0000000000000704","article-title":"Severe hemolytic anemia following intravenous immunoglobulin in an infant with Kawasaki disease","volume":"39","author":"Tocan","year":"2017","journal-title":"J Pediatr Hematol Oncol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.1111\/trf.15859","article-title":"Anti-A\/B isoagglutinin reduction in an intravenous immunoglobulin product and risk of hemolytic anemia: a hospital-based cohort study","volume":"60","author":"Wallenhorst","year":"2020","journal-title":"Transfusion"},{"key":"B9","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1080\/24725625.2019.1681654","article-title":"Autoimmune haemolytic anaemia caused by anti-M antibody in a patient with Kawasaki disease","volume":"4","author":"Shimomura","year":"2020","journal-title":"Mod Rheumatol Case Rep"},{"key":"B10","doi-asserted-by":"publisher","first-page":"855","DOI":"10.1001\/jama.2021.0694","article-title":"Association of intravenous immunoglobulins plus methylprednisolone vs immunoglobulins alone with course of fever in multisystem inflammatory syndrome in children","volume":"325","author":"Ouldali","year":"2020","journal-title":"JAMA"},{"key":"B11","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1056\/NEJMoa2102605","article-title":"Multisystem inflammatory syndrome in children-initial therapy and outcomes","volume":"385","author":"Son","year":"2021","journal-title":"NEJM"},{"key":"B12","doi-asserted-by":"publisher","first-page":"667507","DOI":"10.3389\/fped.2021.667507","article-title":"Best practice recommendations for the diagnosis and management of children with pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS; 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