turnig yellow
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July 12, 2009 at 9:05 am
I have a question, I have mentioned several times in previous post that my son Ryan has a problem with his biliruben level going up when he has IVIG. He goes through Hemolysis (red blood cells breaking down) which in turns causes his biliruben level to go up and he then turns yellow. The doctors watch him closely and there has been some talk about not doing IVIG at all. But we haven’t stopped yet. Our current neuro says there is more benefit to IVIG than him turning yellow and since there is no liver damage he doesn’t want to stop yet.
Has anyone else had problems with biliruben levels going up high and turning yellow (with no liver damage) when recieving IVIG. It didn’t happen every time he got IVIG but in the last 2 months it has happened right after his infusion. so it is happening more often.
Just wondering if anyone else ever had this happen to them.Rhonda
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July 12, 2009 at 9:26 am
Hi Rhonda,
What meds does your son take in conjunction with the infusion? Tylenol, Ibuprophen etc. When I take these, my CMP indicates high liver functions.
My ALT and AST go up but not the BR. Just a thought.–tim– -
July 12, 2009 at 9:43 am
My bilirrubin is going higher each month, and I do not have any IVIG.
My ANA antobodies are negative, si have no lupus or autimmune hepatitis.
The doc thing is another sympthom of autoimmune atack.Pablo
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July 12, 2009 at 9:46 am
How high does Ryan’s bilirubin get? Do other people comment that he is yellow–that is, does it cause self-consciousness? What blood type is he? I also hope that they check his degree of anemia and reticulocyte count a few days after immunoglobulin. If any of these are significant, a couple of suggestions might help. First they could give the infusion slower–such as over two days instead of one or he could move to a smaller dose every two weeks. Second, they could try a dose of steroids–perhaps 4 mg/kg as pretreatment for the immunoglobulin or get a three day pulse of steroids. This is a pretty low dose of steroid (children with asthma typically get 2 mg/kg for 5 days). If it is just a little yellowing without symptoms, you do not need to do anything. There is a small risk of gallstones if this periodic hemolysis continues over years so what out for major yellowing or belly pain in the future. My guess is that he has a less common protein (antigen) on the surface of his red blood cells and that the infused immunoglobulin contains antibodies to this. It is probably NOT the blood type protein, but people naturally make antibodies to A and B antigens because they are very similar to proteins found on some bacteria. Immunoglobulin is produced in batches from a pool of about 1000 blood donors so it may be intermittent in that sometimes there are antibodies to something on Ryan’s red cells and sometimes not.
The other really important point is for Ryan to drink really well, because hemolysis can cause problems with the kidneys. We use sometimes anti-D antibody for an autoimmune process caused ITP. Some people have a good deal of hemolysis with this because D is the red cell antigen that causes one to be RH positive so red blood cells are affected. We suggest the children and adolescents drink lots and lots of fluids after they get this form of immunoglobulin.
WithHope for a cure of these diseases -
July 12, 2009 at 2:06 pm
Ryan gets yellow sometimes even when he didn’t get IVIG. (that started when he got sick with CIDP) he never had a problem withit before getting CIDP. He gets IVIG now every 4 weeks and he gets it for 3 days. They do it at a slow rate and then work up to 200 – 220. he premedicates with 40mg of prednisone and benadryl. He is unable to take Tylenol because they at first thought that was what was causinghim to turn yellow. He was taking it when he first got sick becuse he had really bad headaches. he has tried to ake it since and he turns yellow. But he has been turning yellow recently right after IVIG. the highest his biliruben has been was 20. which is high. normal is less than 1 so 20 is really high. he was admitted to the hospital. but yes he looks like someone took a yellow highlighter to him and colored him yellow.
oh he has had lots of test and he has no liver disease, or hepititus. he has tested negative for everything. -
July 12, 2009 at 6:36 pm
was your son checked for autoimmune hepatitis?
Here is a calculator I´m using with my doc to follow up the liver function test I´m having with high bilirrubin and AST/ALT
[url]http://homepage.mac.com/sholland/contrivances/aihcalc.html[/url] -
July 13, 2009 at 1:41 pm
Just wondering if the brands of ivig were changed. Might want to lower the infusion rate a little to see if there is a difference there also. Has Ryan ever had a reaction to pred? Hopefully the cause will be found soon. Take care.
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