An intravenous IV infusion of a substance made from human blood plasma immunoglobulin may be given. Sometimes you will need to have platelet transfusions. In rare cases, the spleen may need to be removed. Russo MD - Internal Medicine.
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It looks like your browser does not have JavaScript enabled. Please turn on JavaScript and try again. Important Phone Numbers. Top of the page. Overview Immunoglobulin also called gamma globulin or immune globulin is a substance made from human blood plasma.
Immunoglobulin injections may: Give short-term protection against or reduce the severity of certain diseases. It is important that the individual completes this second blood draw to determine the response to the vaccine within this four to six-week timeframe.
Once Ig replacement therapy is started, it is not possible to get accurate results for these important tests without stopping Ig treatment for a few months. Gamma globulin derived from human plasma was first introduced as a treatment option in when gamma globulin was injected intramuscularly IM to treat people with recurrent infections who had antibody immune deficiencies 1.
Dosing was very difficult because only small amounts of gamma globulin could be given in each painful shot. Much scientific investigation in the s and s finally led to a suitable gamma globulin product that could be used intravenously in the early s. People with antibody disorders have been successfully treated with intravenous immunoglobulin replacement therapy IVIG for over 30 years.
With the discovery of well-tolerated preparations of IVIG in the s, the suboptimal, painful IM administration was no longer used 2. In primary or secondary hypogammaglobulinemia low IgG , Ig replacement therapy protects against infections by providing an adequate amount of IgG in the blood 3. Human immunoglobulin plays an important role in the treatment of many diseases, including diseases for which there is no other alternative treatment 3,4.
Currently, more than inflammatory and autoimmune disorders are also treated with IVIG. SCIG can be given in two ways: conventional or facilitated. The facilitated method uses an additional enzyme medication to increase the amount of Ig that can be delivered during each subcutaneous infusion. The individual with PI or caregiver and the prescriber should have a discussion about which route of administration is most appropriate. There are advantages and disadvantages for each route of administration Table IVIG has allowed infusion of higher doses over a short time and historically has been the standard route of administration.
It must be administered by a healthcare professional. This therapy does not require venous access and is associated with the slow release of Ig from the subcutaneous tissues into the blood, which enables IgG levels to remain consistent and steadier between infusions 6. Currently, among those receiving Ig replacement therapy in the U. The individual with PI or caregiver and the prescriber need to make a decision on the route of therapy that is best for the individual person. All options are clinically effective.
There are more than 25 different Ig preparations available worldwide. The preparations vary in a number of ways, including the distribution of IgG subclasses, stabilizers, and infusion details. All Ig products are made from human source plasma.
Source plasma is different than recovered plasma, which is collected through whole blood donation where plasma is separated from its cellular components. This source plasma is pooled from thousands of plasma donations by a process called plasmapheresis in which the liquid part plasma is separated from the red and white cells. The red and white cells are then returned to the patient. This allows a specific donor to return to the plasmapheresis center monthly.
Usually a pool or lot of Ig product is derived from approximately 10, donors. This ensures that a pool or lot of Ig contains a broad spectrum of specific antibodies that are found in the general population which then provide protection to people with PI.
All Ig products licensed in the U. There are multiple safety steps in the production of Ig: donor screening, viral removal, and inactivation of viruses.
All plasma donors undergo a very rigorous screening process that includes a detailed history of infections and risk behaviors, and testing of their plasma for certain viruses using very sensitive techniques.
Donors cannot give their plasma unless they pass this screening. Donors are asked specific questions about risk factors that could affect the safety of the donation and are excluded from donation if risk factors are identified.
Plasma centers can look at the donation history for each donor. The FDA also requires blood centers to maintain lists of unsuitable donors to prevent further donations from these rejected donors. As an added protection, donors must return to donate within a set timeframe for rescreening. If a donor does not return within that timeframe, their prior plasma donation is discarded.
After donation, the individually donated plasma is tested for infectious agents before being pooled with plasma from other donors. The pooled plasma is then divided up and different methods of fractionation and filtration help to separate out the IgG molecules. At multiple times throughout this process, the pool is tested for viral safety before additional safety measures are implemented. This prompted the addition of an extra viral inactivation step in the manufacturing process.
Now multiple safety measures, including pasteurization, low pH, low pH with pepsin, and solvent detergent help dissolve the lipid enveloped viruses, including hepatitis C. An additional safety step is chromatography, a technique widely used to obtain pure ingredients from mixtures. More recently, a final ultrafiltration or depth filtration step has been added to remove the possibility of transmission of prion related diseases mad cow disease.
Transmission of HIV, which is destroyed in the first ethanol fractionation step in the production of Ig, has never been documented with the use of any Ig replacement therapy. Many factors, however, are considered when the medication is prescribed. Doses are adjusted for clinical efficacy, with the expectation of minimizing the frequency and severity of recurrent infections while minimizing side effects of the medication.
IgG levels are usually monitored over time and correlated with the response to therapy. With SCIG, there is a steady level of IgG present in the bloodstream due to the more frequent dosing regimens Figure and slower rate of absorption. The goal is to keep the levels of Ig in the blood stream above a certain level even when the level is at its lowest the trough level right before the next infusion is due.
Uses: IVIG is given through a vein. Most immunologists strongly discourage the use of central catheters to administer IVIG due to the increased risk of serious blood infections and the development of blood clots. Placing a central venous catheter, also known as a port, due to poor venous access increases the risk of infections and blood clots, and it should be strongly discouraged. Given the very serious risk involved with the use of implantable ports, individuals should instead consider switching to the subcutaneous route of administration SCIG if there is a vein access problem.
IVIG is typically given every three-four weeks at a dose determined by the prescriber. Infusions can be given in various settings including an inpatient or outpatient infusion suite, physician office, or in the home.
IVIG is administered by a healthcare professional, and the procedure is scheduled in advance. In special extenuating circumstances, individuals can be instructed to self-infuse this therapy after they are stable on the treatment as long as IV access can be established. The medical professional should, however, stay with the individual for the length of the infusion because of the risk of serious side effects, such as anaphylaxis. Individuals may be at increased risk for developing an adverse reaction if they have never received IVIG, have active infections or pre-existing conditions such as pneumonia or bronchiectasis , or are switching products.
Individuals with a history of migraine headache may be at risk for a postinfusion headache reaction. The prescriber of the therapy can modify IVIG dosing by decreasing the rate of infusion or adding other medications to the prescription.
Medications such as acetaminophen, diphenhydramine, non-steroidal anti-inflammatory drugs, or corticosteroids can help prevent side effects during and after an infusion. It is important to know, however, that repeated use of corticosteroids used to manage IVIG side effects may lead to longterm problems associated with repeated steroid use.
While IVIG brands differ by manufacturer, the listed side effects are virtually identical on each package insert. Some common infusion reactions are headache, nausea, fever, chills, flushing, wheezing, vomiting, backache, muscle aches, joint aches, or chest tightness.
Side effects experienced during an infusion of Ig are almost always related to the rate of the infusion, such as infusing too fast, or relate to the temperature of the product. Stopping or slowing the infusion is usually the only intervention needed to alleviate these symptoms.
Sometimes a switch in product is successful in alleviating these side effects as some may simply tolerate one brand better than another. Some side effects can happen up to 72 hours after an infusion of Ig. These delayed symptoms are not usually associated with the rate of infusion. Some rare side effects include:. What Side Effects to Report to the Prescriber: The individual with PI or caregiver is responsible for reporting any side effects or discomforts experienced during or after an infusion of IVIG to the prescriber of the therapy and to the nurse administering the therapy.
Side effects to report include but are not limited to:. Optimized Infusion Experience : A nurse trained in the administration of this therapy and the appropriate place of administration for IVIG is important.
Many of the side effects that happen during an infusion are related to rate. The nurse should be experienced in infusing this medication and aware of when to slow down the rate of infusion or stop the infusion if necessary. The immunoglobulin may prevent or reduce the severity of the illness if given shortly after exposure.
The time period during which an injection provides this benefit ranges from days to months, depending on the disease. Immunoglobulins do not provide long-term protection in the same way as a traditional vaccine. The protection they provide is short-term, usually lasting a few months. It is still possible to get the disease after the immunoglobulin has worn off. When an Rh-negative woman becomes pregnant with an Rh-positive fetus which can occur when the father's blood is Rh-positive , the pregnant woman's immune system makes antibodies that can destroy the fetus's blood in a future pregnancy.
This antibody response is called Rh sensitization and occurs only if the fetus's blood mixes with the pregnant woman's, which can happen during birth. To prevent Rh sensitization during pregnancy, you must have an Rh immunoglobulin injection if you are Rh-negative. This is done during your pregnancy and after delivery to protect the fetus of a future pregnancy. Immunoglobulin is sometimes used to treat immune thrombocytopenic purpura ITP , an immune disorder in which the body attacks the cells responsible for blood clotting platelets , resulting in bleeding.
The cause of ITP is not known. People who have this disorder may have bruises or black-and-blue marks purpura on the skin. Internal bleeding is a more serious complication that can occur.
Some cases of ITP may go away on their own and do not require treatment. In other cases, treatment may be needed to prevent bleeding. Some medicines can help the body make more platelets. Steroids such as prednisone or other medicines may be needed to suppress the immune system.
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