Clin Pediatr Hematol Oncol.  2016 Oct;23(2):162-166. 10.15264/cpho.2016.23.2.162.

Autoimmune Hemolytic Anemia after Intravenous Immunoglobulin Therapy in a Child with Kawasaki Disease

• Moon JW
• Lee SH
• Oh YK
• Choi DY
• Yu ST

• KMID: 2358372
• DOI: http://doi.org/10.15264/cpho.2016.23.2.162

Abstract

Kawasaki disease (KD) can cause acquired heart disease and systemic vasculitis in children. It is treated with intravenous immunoglobulin (IVIG). A significant complication is development of coronary artery lesions such as dilatations or aneurysms. However, uncommon complications can occur, like autoimmune hemolytic anemia when IVIG is used. We present a case of autoimmune hemolytic anemia associated with KD. Dilatation of right coronary artery was found at echocardiography and he was treated twice with IVIG (2 g/kg) with interval of 48 hours. Laboratory finding showed hemoglobin 7.1 g/dL, hematocrit 20.8%, corrected reticulocyte 5.86%, total bilirubin 0.29 mg/dL, lactate dehydrogenase 425 IU/L, and haptoglobin 5 mg/dL. Normocytic, normochromic anemia with anisopoikilocytosis was found on peripheral blood smear, and direct antiglobulin test was positive. The patient was started on oral prednisolone for 3 weeks, with which all symptoms resolved. We report this rare case, prompting consideration of IVIG associated complications when treating KD.

Keyword

Autoimmune hemolytic anemia; Kawasaki disease; Intravenous immunoglobulins

MeSH Terms

Anemia
Anemia, Hemolytic, Autoimmune*
Aneurysm
Bilirubin
Child*
Coombs Test
Coronary Vessels
Dilatation
Echocardiography
Haptoglobins
Heart Diseases
Hematocrit
Humans
Immunization, Passive*
Immunoglobulins*
Immunoglobulins, Intravenous
L-Lactate Dehydrogenase
Mucocutaneous Lymph Node Syndrome*
Prednisolone
Reticulocytes
Systemic Vasculitis
Bilirubin
Haptoglobins
Immunoglobulins
Immunoglobulins, Intravenous
L-Lactate Dehydrogenase
Prednisolone