Strokes after intravenous gamma globulin: Thrombotic phenomenon in patients with risk factors or just coincidence?

• Published in: American journal of hematology Vol. 78; no. 3; pp. 216 - 220
• Main Authors: Alexandrescu, Doru T., Dutcher, Janice P., Hughes, John T., Kaplan, Jerry, Wiernik, Peter H.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.03.2005; Wiley-Liss
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; cerebral vascular accident; Chronic Disease; chronic inflammatory demyelinating polyneuropathy; CIDP; CVA; Demyelinating Diseases - complications; Demyelinating Diseases - drug therapy; Female; Hematologic and hematopoietic diseases; Humans; Immunoglobulins, Intravenous - adverse effects; Immunoglobulins, Intravenous - therapeutic use; intravenous immunoglobulin; Magnetic Resonance Angiography; Medical sciences; Neurology; Polyneuropathies - complications; Polyneuropathies - drug therapy; Risk Factors; serum viscosity; Stroke - diagnosis; Stroke - etiology; thromboembolism; Thromboembolism - diagnosis; Thromboembolism - etiology; Vascular diseases and vascular malformations of the nervous system; Viscosity; chronic inflammatory demyelinating polyneuropathy; serum viscosity; Intravenous administration; Cardiovascular disease; Polyneuropathy; Epidemiology; Globulin; Vascular disease; Blood vessel; Serum; Peripheral nerve disease; Thromboembolism; intravenous immunoglobulin; Cerebrovascular disease; Human; Nervous system diseases; Stroke; Immunoglobulins; Hematology; Inflammation; Thrombosis; CIDP; Embolism; Cerebral disorder; CVA; Chronic; Central nervous system disease; Risk factor; Circulatory system; cerebral vascular accident
• ISSN: 0361-8609; 1096-8652
• DOI: 10.1002/ajh.20287

We report the case of an 82‐year‐old woman with a diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) for more than 10 years, who developed an ischemic stroke during infusion of immunoglobulin (IVIG). She had received IVIG intermittently for several years, and the previous 86 doses were well tolerated. Thromboembolism was suspected based on magnetic resonance angiogram and on further extension of the deficit after 4 days of evolution. Strokes were associated with the use of IVIG in different clinical circumstances. Pre‐existing thrombogenic risk factors should be carefully considered for patients undergoing treatment with IVIG. Clinical evaluation, with attention to history, a focused vascular work‐up, and looking for markers of dehydration, can identify the high‐risk patient for whom a careful analysis of the risk/benefit ratio is warranted. Am. J. Hematol. 78:216–220, 2005. © 2005 Wiley‐Liss, Inc.