IV immunoglobulin

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Created May 2007 by Charles Gomersall

Preparation

• batched blood product prepared from 1,00-15,000 plasmapheresis and blood donations
• >95% IgG with trace amounts of IgM and IgA
• there are significant differences in donor pool, stabilizers, additives and production processes between different manufacturers. Patients should receive the same brand with each course/dose because:
  • limiting exposure to a minimum donor pool reduces risk of infection
  • changing products is associated with a higher risk of adverse reactions

Clinical uses

Replacement therapy

• Primary antibody deficiencies
• Secondary antibody deficiences
  • chronic lymphatic leukaemia
  • multiple myeloma

Immunomodulatory therapy

Neurological disorders

Established therapy for:

• Guillain-Barre
• Multifocal motor neuropathy with conduction block
• Chronic inflammatory demyelinating polyneuropathy

Some evidence of efficacy for:

• myasthenia gravis unresponsive to other therapies
• Eaton-Lambert syndrome

Dermatological disorders

• Kawasaki disease. Reduces incidence of coronary aneurysms if given within 10 days of symptom onset
• Blistering disorders (eg pemphigus, pemphigoid) frequently treated with IVIG although controlled data supporting efficacy is limited
• Toxic epidermal necrolysis - again evidence of efficacy is limited

Vasculitic disorders

• ANCA associated systemic vasculitis - effective adjunctive therapy

Infection

• Some evidence of benefit in streptococcal toxic shock syndrome
• Recent meta-analysis suggests may reduce mortality in critically ill septic patients

Adverse effects

Immediate

• headaches, backache, chills, nausea, myalgia
  • usually infusion rate-related
  • more common in patients with co-existing infection
• anaphylaxis (very rare)

Transmission of infection

• Hepatitis C
  • most manufacturers have introduced additional precautions since last outbreak

Due to increasing serum immunoglobulin

• reversible renal impairment
• cerebral and coronary thromboses
• acute haemolysis
• neutropaenia
• acute aseptic meningitis
• eczema, urticaria, erythema multiforme, cutaneous vasculitis

Further reading

©Charles Gomersall, August, 2008 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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