Chapter 4: Immuneglobulin Products Flashcards
IVIG
List 3 types of immune globulin products provided by CBS.
IVIg
SCIg
RhIg
IVIG
How do immuneglobulin products affect vaccine efficacy?
IVIig leads to decreased response to parenteral live virus vaccines
BUT NOT inactivated virus vaccines Live oral/intranasal vaccines, or BCG
IVIG
What formats do immuneglobulin products come in?
sterile solutions
lyophilized concentrates
IVIG
What class of human immunoglobulin are immuneglobulin products made from?
IgG
May have traces of others
How can Immunoglobulin administration affect serological testing results?
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
Tests needs to be performed befor IVIG
Why should we do hepatitis B testing with hepatitis B surface antigen (HBsAg) in patients before Ig therapy is initiated?
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
What resource can you consult of you want to know what Ig products are offered by CBS?
E-formulary for plasma protein and related products
IVIG mechanism
What is the method of action by which IVIg offers protection against infection and supplementation for congenital/primary and acquired/secondary immune deficiency
By supplementing array of IgG antibodies to facilitate destruction and neutralization of pathogens
IVIG mechanism
What is the proposed mechanism by which IVIg helps with immune modulation in autoimmune or modulatory conditions
anti-inflammatory activity by dendritic cells and/or blockade of Fc receptors in the reticuloendothelial system
IVIG mechanism
What is the proposed mechanism by which IVIg helps with immune modulation in autoimmune or modulatory conditions
anti-inflammatory activity by dendritic cells and/or blockade of Fc receptors in the reticuloendothelial system
IVIG mechanism
What is the proposed mechanism by which RhIg prevents alloimmunization against RhD?
Accelerated clearance of RhIg coated cells
Suppression of B-cell mediated response to Rh exposure and mitigation of Rh alloimmunization
IVIG indication
List 6 indications for IVIg
Primary immune deficiency (PID)
Secondary immune deficiency (SID)
ITP
Chronic inflammatory demyelinating polyneuropathy (CIDP)
Guillain-Barré syndrome (GBS)
Multifocal motor neuropathy (MMN)
IVIG
Why are there authorization forms for IVIg ordering and who provides regional guidance on the use of IVIg in Canada?
BC blood coordinating office
ORBCoN
Atlantic blood utilization strategy working group
IVIG criteria for the clinical use
What group developedcriteria for the clinical use of Igas part of an evidence-based framework to aid transfusion services and clinicians?
Prairie Collaborative Immune Globulin Utilization Management Framework Project
IVIG guidance on utilization
Who provides guidance on utilization of there are Ig shortages in Canada?
National Advisory Committee on Blood and Blood Products (NAC)
IVIG-Contraindication
IVIg is contraindicated for what groups of individuals?
People with:
IgA deficiency and anti-IgA antibodies
Prior anaphylaxis or multiple severe allergic reactions
IVIG-IgA
What Ig products can you use for individuals with IgA deficiency who have anti-IgA antibodies instead of IVIg?
SCIg
IVIG-IgA
Do we routinely test for IgA deficiency before IVIg?
No
IVIG dose
IVIG dosing?
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
IVIG side effects
General side effects of IVIG
What does it related to?
- Lower doses associated with less side effects
- Minor side effects with infusion - headache, chills, fever, malaise, anxiety, chest pain, nausea, pruritus, rash, nausea/vomiting, tachycardia, hypo or hypertension
o Common (21%)
o Related to infusion rate and will resolve by slowing or stopping IVIG infusion
o Premedication
o Trial different brand or switch to SCIG if appropriate