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CBS Clinical Guide, Even Numbered Chapters > Chapter 4: Immuneglobulin Products > Flashcards

Chapter 4: Immuneglobulin Products Flashcards

1
Q

List 3 types of immune globulin products provided by CBS.

A

IVIg
SCIg
RhIg

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2
Q

How do immuneglobulin products affect vaccine efficacy?

A

IVIig leads to decreased response to parenteral live virus vaccines
BUT NOT inactivated virus vaccines Live oral/intranasal vaccines, or BCG

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3
Q

What formats do immuneglobulin products come in?

A

sterile solutions
lyophilized concentrates

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4
Q

What class of human immunoglobulin are immuneglobulin products made from?

A

IgG

May have traces of others

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5
Q

How can Immunoglobulin administration affect serological testing results?

A

passively transferred antibodies in the patient’s blood may cause positive serological testing results, which can be misinterpreted

E.g.:

Passive transmission of antibodies to red cell antigens (e.g., A, B, and D) may cause a positive direct or indirect antiglobulin (Coombs) test.

serological testing results for other antibody-mediated tests (e.g., hepatitis B core antibody [anti-HBc], hepatitis A, varicella) may also be misleading

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6
Q

Why should we do hepatitis B testing with hepatitis B surface antigen (HBsAg) in patients before Ig therapy is initiated?

A

After Ig administration, serological testing results for hepatitis B core antibody [anti-HBc], hepatitis A, may be misleading.

We should test before giving Ig to inform the risk of hepatitis B reactivation

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7
Q

What resource can you consult of you want to know what Ig products are offered by CBS?

A

E-formulary for plasma protein and related products

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8
Q

What is the method of action by which IVIg offers protection against infection and supplementation for congenital/primary and acquired/secondary immune deficiency

A

By supplementing array of IgG antibodies to facilitate destruction and neutralization of pathogens

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9
Q

What is the proposed mechanism by which IVIg helps with immune modulation in autoimmune or modulatory conditions

A

anti-inflammatory activity by dendritic cells and/or blockade of Fc receptors in the reticuloendothelial system

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10
Q

What is the proposed mechanism by which IVIg helps with immune modulation in autoimmune or modulatory conditions

A

anti-inflammatory activity by dendritic cells and/or blockade of Fc receptors in the reticuloendothelial system

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11
Q

What is the proposed mechanism by which RhIg prevents alloimmunization against RhD?

A

Accelerated clearance of RhIg coated cells

Suppression of B-cell mediated response to Rh exposure and mitigation of Rh alloimmunization

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12
Q

List 6 indications for IVIg

A

Primary immune deficiency (PID)
Secondary immune deficiency (SID)
ITP
Chronic inflammatory demyelinating polyneuropathy (CIDP)
Guillain-Barré syndrome (GBS)
Multifocal motor neuropathy (MMN)

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13
Q

Why are there authorization forms for IVIg ordering and who provides regional guidance on the use of IVIg in Canada?

A

BC blood coordinating office
ORBCoN
Atlantic blood utilization strategy working group

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14
Q

What group developedcriteria for the clinical use of Igas part of an evidence-based framework to aid transfusion services and clinicians?

A

Prairie Collaborative Immune Globulin Utilization Management Framework Project

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15
Q

Who provides guidance on utilization of there are Ig shortages in Canada?

A

National Advisory Committee on Blood and Blood Products (NAC)

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16
Q

IVIg is contraindicated for what groups of individuals?

A

People with:
IgA deficiency and anti-IgA antibodies
Prior anaphylaxis or multiple severe allergic reactions

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17
Q

What Ig products can you use for individuals with IgA deficiency who have anti-IgA antibodies instead of IVIg?

A

SCIg

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18
Q

Do we routinely test for IgA deficiency before IVIg?

A

No

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19
Q

IVIG dosing?

A

Depends on clinical indication

Immune replacement 0.4–0.6 g/kg a month + extra dose in the first month of therapy if serum IgG low

Immunosuppressive dose: 1–2 g/kg over 1–5 days, and some conditions may require ongoing maintenance therapy, usually given monthly, with efforts made to reduce the dose or extend the treatment interva

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20
Q

IVIG dosing?

A

Depends on clinical indication

Immune replacement 0.4–0.6 g/kg a month + extra dose in the first month of therapy if serum IgG low

Immunosuppressive dose: 1–2 g/kg over 1–5 days, +/- monthly maintenance

Reduce the dose or extend the treatment interval as tolerated

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21
Q

IVIg hemolysis mechanism?*

A
22
Q

Contraindications to IVIg?

A

IgA deficiency with anti-IgA antibodies. Can try SCIg with such patients instead.

23
Q

Alternative for patients who have had anaphylaxis or multiple severe reactions to IVIg?

A

S/D plasma

24
Q

Privigen contraindications?

A

Same as IVIg plus hyperprolinemia

25
Q

Weight adjusted dosing for immune globulin products- what is the formula?

A

Dosing weight = ideal weight + [0.4x (actual weight - ideal weight)]

If patient weight is less than IBW, or patient is a child, use actual weight

26
Q

Weight adjusted dosing for immune globulin products- what is the formula?

A

Dosing weight = ideal weight + [0.4x (actual weight - ideal weight)]

If patient weight is less than IBW, or patient is a child, use actual weight

27
Q

How is ideal body weight calculated?

A

Male @ birth: 50 kg + 2.3 kg/ inch over 5 ft
Female @ birth: 45.5 kg x 2.3 kg,/inch over 5 ft

28
Q

IVIg infusion rate?

A

0.01 mL/kg/min
Increase or decrease based on patient tolerance

29
Q

IVIg storage temperature?

A

2-25 degrees C

30
Q

IVIg adverse events? How to manage,?

A

Minor:
H/a
Fever, chills
Anxiety
Nausea
Pruritis/rash
Chest pain

Slow infusion rate, stop infusion, premedicate, switch product

Severe:
Hemolysis
Aseptic meningitis
Anaphylaxis
TRALI
Thromboembolism

31
Q

Is IVIg hemolysis usually DAT pos or neg?

A

DAT Positive

32
Q

Define IVIg associated hemolysis

A

Drop of Hgb by 10 or more
Positive DAT
Within 10 days of IVIg

AND (need at least 2):
Increased retics
Increased LDH
Low hapto
Increased unconjugated bili
Red serum hemoglobinemia
Hemoglobinuria
Spherocytosis

33
Q

Define IVIg associated hemolysis

A

Drop of Hgb by 10 or more
Positive DAT
Within 10 days of IVIg

AND (need at least 2):
Increased retics
Increased LDH
Low hapto
Increased unconjugated bili
Red serum hemoglobinemia
Hemoglobinuria
Spherocytosis

34
Q

What increases risk of IVIg hemolysis?

A

High dose especially at 2g/kg
Non O blood group due to passive transfer of anti-A and anti-B isohemagglutins and density of A and B Ag on RBC surface

Highway Rush: group A pr SB patient getting 2g/kg or higher

35
Q

Cause of aseptic meningitis from IVIg? How to recognize aseptic meningitis?

A

Dose related
Typically occurs within 6-48 hours
CSF shows high protein, normal to low glucose, WBC pleocytosis, neg cultures
Recovery within 5 days
Possible future recurrence with IVIg

36
Q

Anaphylaxis in IVIg

A

IgA deficiency with anti IgA antibodies
Significance of Ab Class (IgG vs IgE anti-IgA)

Can try SCIg or IgA depleted products

37
Q

Anaphylaxis in IVIg

A

IgA deficiency with anti IgA antibodies
Significance of Ab Class (IgG vs IgE anti-IgA)

Can try SCIg or IgA depleted products

38
Q

What Thromboembolic events can occur with IVIg?

A

CVA
TIA
DVT
PE
Retinal vein occlusion
Retinal artery infarct

39
Q

Timeframe of IVIg related thromboembolism in relation to IVIg infusion?

A

During or up to 8 days after

40
Q

Timeframe of IVIg related thromboembolism in relation to IVIg infusion?

A

During or up to 8 days after

41
Q

Patients at increased risk of IVIg related thromboembolism?

A

CV disease
Immobilization
Advanced age
H/o Thromboembolic events

Mitigate risk by hydration, monitoring, slow infusion, lower doses

42
Q

SCIg indications?

A

Replacement therapy in PID or SID (lifelong)

Immunomodulation in CIDP

43
Q

Benefits of SCIg over IVIg?

A

Convenience/lifestyle
No vascular access needed
Less truth of side effects

44
Q

SCIg contraindications?

A

History of anaphylactic or severe allergic reactions to Ig products (but this is also a reason who patients switch from IVIg to SCIg … Confusing)

45
Q

Storage temperature of SCIg?

A

2-25C

46
Q

Dose and administration of SCIg?

A

Depends on brand
100-200 mg/kg,/wk plus extra 0.4 g/kg n first month if very low serum IgG
Administration rate varies

47
Q

Dose and administration of SCIg?

A

Depends on brand
100-200 mg/kg,/wk plus extra 0.4 g/kg n first month if very low serum IgG
Administration rate varies

48
Q

Calculation for switching from IVIg to SCIg?

A

Divide monthly IVIg dose by 4 to get weekly SCIg dose then titrate to get trough levels at bottom of serim IgG ref range for age

Average dude 100-125 mg/kg/wk

Can give cumulatively q 3-4 weeks thereafter

49
Q

Adverse reactions with SCIg?

A

Similar to IVIg

50
Q

What are hyperimmune globulin fractionation products?

A

Mar from pooled plasma
Select for high Ab titres with desired specificities
Viral inactivation

51
Q

hyperimmune globulin products?

A

RhIg
Hep B Ig

VZV Ig
CMV Ig
Intramuscular Ig

52
Q

Storage temperature for hyperimmune globulin products?

A

2-8C
User within 4 hours of reconstitution

CBS Clinical Guide, Even Numbered Chapters (3 decks)

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