Immunoglobulins

Immunoglobulins - human normal immunoglobulin is prepared by cold alcohol fractionation of pooled plasma from over 1000 donations. Individual donor units of plasma are screened for hepatitis B surface antigen (HBsAg) and for the presence of antibodies to human immunodeficiency virus type 1 (HIV-1), HIV-2 or hepatitis C virus (HCV) which, combined with careful donor selection, minimises the risk of viral transmission. In addition, the testing for HBsAg,HIV-1,HIV-2 and HCV antibodies is repeated on the plasma pools.

Uses
Guillain-Barré syndrome
Weakness during exacerbations in Myasthenia Gravis (unlicensed)
Toxic shock syndromes (unlicensed)

Contraindications
Patients with known class specific antibody to IgA (risk of anaphylactoid reactions)

Administration
• For Guillain–Barré syndrome and myasthenia gravis
IV infusion: 0.4 g/kg IV daily for 5 consecutive days. Repeat at 4-week intervals if necessary
Patient treated for the first time: give at rate of 30 ml/h, if no adverse effects occur within 15 min, increase rate to maximum of 150 ml/h
Subsequent infusions: give at rate of 100 ml/h
• Toxic shock: 1 g/kg day 1, then 0.5 g/kg for days 2 and 3 (this regimen was used by Darenberg J, et al. CID 2003; 37: 333–40)
Certain immunoglobulins require refrigeration. These should be allowed to reach room temperature before administration. Once reconstituted, avoid shaking the bottle (risk of foaming).The solution should be used only if it is clear, and given without delay.

How not to use immunoglobulins
Should not be mixed with any other drug and should always be given through a separate infusion line
Live virus vaccines (except yellow fever) should be given at least 3 weeks before or 3 months after an injection of normal immunoglobulin
Doses are not necessarily interchangeable between different IVIG products, check product literature on

Adverse effects
Chills
Fever
Transient serum creatinine
Anaphylaxis (rare)