IVIG Induced Hemolytic Anemia

Intravenous immunoglobulin (IVIG) is derived from donated plasma used to treat immune deficiency, autoimmune, and inflammatory disorders. Adverse effects occur in 5-15% of patients with hemolytic anemia being a delayed reaction. Risk factors for hemolysis are high-dose infusions (1-2g/kg/day or \u3e100g/day), female sex, and non-O blood group. Our case involves a 69-year old male presetting with bilateral lower extremity weakness for 1 year after sustaining a fall, affecting his ability to ambulate with no bowel or urinary incontinence. MRI revealed spondylotic changes of the lumbar spine. EMG showed severe bilateral lumbosacral polyradiculopathy with ongoing denervation and severe sensorimotor peripheral polyneuropathy with axonal loss. He was diagnosed with chronic inflammatory demyelinating polyneuropathy and started on high-dose IVIG (0.4mg/kg; 77.6mg) therapy for 5 days. 48 hours after IVIG completion, patient developed acute drop in hemoglobin (9.1 g/dL to 7.0 g/dL) that continued to down-trend (5.7 g/dL). Type and screen was AB positive. Labs were significant for elevated absolute reticulocyte count (141.5 K/uL), reticulocyte percentage (6.1%), and LDH (321 IU/L) while haptoglobin was low (\u3c30.0 mg/dL), consistent with hemolytic anemia. Direct antiglobulin anti-IgG coombs test was positive and anti-complement negative, consistent with immunohemolytic anemia. He was supported with blood transfusion and continued on high-dose Prednisone (1mg/kg/day) for 3 months. Antibodies present in IVIG product react with RBC antigens predominantly of the ABO blood group, causing intravascular hemolysis. Although IVIG induced hemolysis is typically mild and self-limiting, it can often go undetected and prescribers should be aware.https://scholarlycommons.henryford.com/merf2020caserpt/1138/thumbnail.jp

Detection of somatostatin receptors in human osteosarcoma

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Clinical and Epidemiologic Characterization of WU Polyomavirus Infection, St. Louis, Missouri

WU polyomavirus is a recently described polyomavirus found in patients with respiratory infections. Of 2,637 respiratory samples tested in St. Louis, Missouri, 2.7% were positive for WU polyomavirus by PCR, and 71% were coinfected with other respiratory viruses. Persistent human infection with WU polyomavirus is described

Effectiveness of a clinical practice guideline implementation strategy for patients with anxiety disorders in primary care: cluster randomized trial

<p>Abstract</p> <p>Background</p> <p>Anxiety is a common mental health problem seen in primary care. However, its management in clinical practice varies greatly. Clinical practice guidelines (CPGs) have the potential to reduce variations and improve the care received by patients by promoting interventions of proven benefit. However, uptake and adherence to their recommendations can be low.</p> <p>Method/design</p> <p>This study involves a community based on cluster randomized trial in primary healthcare centres in the Madrid Region (Spain). The project aims to determine whether the use of implementation strategy (including training session, information, opinion leader, reminders, audit, and feed-back) of CPG for patients with anxiety disorders in primary care is more effective than usual diffusion.</p> <p>The number of patients required is 296 (148 in each arm), all older than 18 years and diagnosed with generalized anxiety disorder, panic disorder, and panic attacks by the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). They are chosen by consecutive sampling.</p> <p>The main outcome variable is the change in two or more points into Goldberg anxiety scale at six and twelve months. Secondary outcome variables include quality of life (EuroQol 5D), and degree of compliance with the CPG recommendations on treatment, information, and referrals to mental health services. Main effectiveness will be analyzed by comparing the patients percentage improvement on the Goldberg scale between the intervention group and the control group. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis.</p> <p>Discussion</p> <p>There is a need to identify effective implementation strategies for CPG for the management of anxiety disorders present in primary care. Ensuring the appropriate uptake of guideline recommendations can reduce clinical variation and improve the care patients receive.</p> <p>Trial registration</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN83365316">ISRCTN83365316</a></p