Immunoglobulins Flashcards
Define immunoglobulins
Antibodies of human origin
Antiserum = material prepared in animals
Why have injections of antiserum (prepared in animals) mostly been replaced with the use of immunoglobulins (human origin)?
Serum sickness and other allergic-type reactions that may follow injections of antiserum
Reactions are possible with human immunoglobulins but are very rare
(?) contains IgG and antibodies to hepatitis A, measles, mumps, rubella, varicella, and other viruses that are currently prevalent in the general population
Human normal immunoglobulin
Human normal immunoglobulin contains IgG and antibodies to (1?), (2?), (3?), (4?), (5?), and other viruses that are currently prevalent in the general population
- Hepatitis A
- Measles
- Mumps
- Rubella
- Varicella
Normal immunoglobulin (containing 10-18% protein) is administered by IM injection for the protection of susceptible contacts against which viruses? (3)
Hepatitis A
Measles
Rubella
What is the mode of administration of normal immunoglobulin (containing 10-18% protein) used for the protection of susceptible contacts against hepatitis A, measles and rubella?
IM injection
Normal immunoglobulin (containing 3%–12% protein) for intravenous administration is used as replacement therapy for patients with (1?) and (2?), and for the short-term treatment of idiopathic thrombocytopenic purpura and Kawasaki disease; it is also used for the prophylaxis of infection following bone-marrow transplantation and in children with symptomatic HIV infection who have recurrent bacterial infections.
- Congenital agammaglobulinaemia
2. Hypogammaglobulinaemia
Normal immunoglobulin (containing 3%–12% protein) for intravenous administration is used as replacement therapy for patients with congenital agammaglobulinaemia and hypogammaglobulinaemia, and for the short-term treatment of (1?) and (2?); it is also used for the prophylaxis of infection following bone-marrow transplantation and in children with symptomatic HIV infection who have recurrent bacterial infections.
- Idiopathic thrombocytopenic purpura
2. Kawasaki disease
Normal immunoglobulin (containing 3%–12% protein) for intravenous administration is used as replacement therapy for patients with congenital agammaglobulinaemia and hypogammaglobulinaemia, and for the short-term treatment of idiopathic thrombocytopenic purpura and Kawasaki disease; it is also used for the prophylaxis of infection following (1?) and in children with (2?) who have recurrent bacterial infections.
- Bone marrow transplantation
2. Symptomatic HIV infection
What is the preferred mode of administration of normal immunoglobulin (containing 3-12% protein) when used as replacement therapy?
IV
Can also be given IM or subcutaneously but IV is preferred
Which close contacts of the index case with hepatitis A are considered for treatment with normal immunoglobulin in addition to the monovalent hepatitis A vaccine?
Chronic liver disease (including chronic hepatitis B or C)
HIV infection (CD4 count < 200)
Immunosuppressed
Aged 60 years and over
Give within 14 days of exposure (up to 28 days in those with chronic liver disease)
IV or subcutaneous normal immunoglobulin given to patients with compromised immunity who come into contact with measles is most effective if given within (1?) hours but can be effective if given within (2?) days of exposure
- 72 hours
2. 6 days
Who should be considered for subcutaneous or IM normal immunoglobulin if they have been in contact with a confirmed case of measles or with a person associated with a local outbreak of measles?
- Non-immune pregnant women
- Infants under 9 months
Compromised immunity need IV or subcutaneous normal immunoglobulin
Everyone else can be given the MMR vaccine (live) for prophylaxis following exposure to measles
Does IM normal immunoglobulin prevent infection in non-immune contacts after exposure to rubella?
NO
IM normal immunoglobulin is NOT recommended for protection of pregnant women exposed to rubella.
It may, however, reduce the likelihood of a clinical attack which may possibly reduce the risk to the fetus.
Intramuscular normal immunoglobulin should be used only if termination of pregnancy would be unacceptable to the pregnant woman—it should be given as soon as possible after exposure.
The risk of intrauterine transmission of rubella is greatest in the (1) weeks of pregnancy, between 16 and 20 weeks there is minimal risk of deafness only, after 20 weeks there is no increased risk.
First 11 weeks
The risk of intrauterine transmission of rubella is greatest in the first 11 weeks of pregnancy, between 16 and 20 weeks there is (?) risk of deafness only, after 20 weeks there is no increased risk.
minimal
The risk of intrauterine transmission of rubella is greatest in the first 11 weeks of pregnancy, between 16 and 20 weeks there is minimal risk of deafness only, after 20 weeks there is (?) risk.
no increased
If tetanus immunoglobulin is not available following exposure to tetanus, what can be used as an alternative?
Normal immunglobulin [unlicensed]
IV tetanus immunoglobulin is no longer available in the UK. Therefore, IV normal immunoglobulin is recommended.
Are there specific immunoglobulins for hepatitis A, measles, or rubella?
NO
Normal immunoglobulin is used when required
What should be given in addition to the hepatitis B vaccine for post-exposure prophylaxis of individuals in certain high-risk groups to provide rapid protection against hepatitis B until the vaccine become effective?
Hepatitis B immunoglobulin (HBIG)
HBIG is also recommended in some known non-responders to the hepatitis B vaccine
What should be considered following high risk exposure to rabies to give rapid protection until rabies vaccine becomes effective?
Rabies immunoglobulin
What is the recommended site of injection of rabies immunoglobulin following a wound that is considered a high-risk exposure site?
Around the site of the wound (not IM) as it neutralises rabies virus before the immune system can respond
There is limited benefit of IM administration away from the wound
Which individuals are varicella-zoster immunoglobulin (VZIG) recommended for?
- Significant exposure to varicella (chickenpox) or herpes zoster (shingles)
- Clinical condition that increases the risk of severe chickenpox
- No antibodies to varicella zoster virus
Up to which gestation of pregnancy are women considered most vulnerable to varicella-zoster and have varicella-zoster immunoglobulin stock prioritised for them if exposed?
Up to 20 weeks of gestation
Due to a significant shortage of varicella-zoster immunoglobulin, stock has been prioritised for the most vulnerable groups, such as susceptible women exposed in the first 20 weeks of pregnancy. For susceptible pregnant women exposed after 20 weeks (from 21 weeks to delivery), either varicella-zoster immunoglobulin or aciclovir [unlicensed] is recommended; valaciclovir [unlicensed] may be used as an alternative.
Anti-D (Rh0) immunoglobulin should be administered to the mother within (?) hours of any sensitizing event (e.g. abortion, miscarriage, birth)
72 hours
What is used to determine the dose of anti-D (Rh0) immunoglobulin to mothers following a sensitizing event?
level of exposure to rhesus-positive blood
Apart from in rhesus-negative pregnant women, what other indications are there for anti-D (Rh0) immunoglobulin?
- Women of child-bearing potential after the inadvertent transfusion of rhesus-incompatible blood components
- In the treatment of idiopathic thrombocytopenia purpura
If you are giving both the MMR (live) vaccine and anti-D (Rh0) immunoglobulin to a postpartum woman at the same time, what must you remember about the injection site?
Administer them separately in different limbs
