IVIG Flashcards
Which immunoglobulins predominant IVIG? Human or chimeric?
IgG, with traces of IgA, M and others
human from 1000s of donors
half life of IVIG
3-5 weeks
pregnancy safety of IVIG?
category C
crosses placenta and excreted in BM
MOA of IVIG - name 5?
FASt CAT moving slow on steroids
block of FAS/FAS ligand interaction - blocks keratino apoptosis
C - complement inhibition of C3/C5 converses, MAC
A - antibody production of existing B cells reduced
A - ending and decreasing circulating antibodies and downregulating Fc receptors by saturating them
T - T regs increased
T - auto reactive T cells decreased
T - suppressive on T cells, neutralizing antibodies and downregulating stimulatory T cell molecules
moving slow - affects migration of immune cells
moving slow - inhibits cellular adhesion and migration into tissue of inflammatory cells
on steroids - synergy with CS.
IVIG peak
immediately after infusion
5 clinical indications for ivig?
Kawasaki, autoimmune bullous d/o (blocks Bs) BP, PV, PF, EBA, pemph gestationis, LABD DM scleroderma SLE chronic autoimmune urticaria AD GVHD
on label indications for IVIG in Canada?
SCID and ITP (no direct cut conditions)
IVIG is approved from what age in Canada
3+
dosing of IVIG?
2 g/kg w/ ASA for Kawasaki DM: 2 g/kg/day x 2 days scleroderma: 2 g/kg/day monthly PV/PF/BP etc - 2 g/kg/day mostly EBA 400 mg/kg/d x 5 days then Q4w
C/I for IVIG?
hypersensitivity to IVIG or any of its components
CHF
renal failure
IgA deficiency (incr risk of anaphylaxis)
RA and cryoglobulinemia (increased risk of renal failure)
pregnancy C
Adverse effects of IVIG - list 5 buckets with 2-3 examples in each?
infusion related:
develop w/i 30-60 mins
headache, myalgia, flushing, chills, NV
prevent by loading w/ CS, antihistamines, analgesics
anaphylaxis - incr in IgA deficiency
fluid overload - acute renal failure
cardiac - MI, CVA - risk lowered w/ decreased infusion rate
theoretic risk of infection transfer from donor
IMPORTANT: aseptic meningitis in 11%; self-limiting, treat symptomatically
neutropenia and hemolysis
monitoring for IVIG?
baseline: CBC, LFTs, renal function, IgA, RF, cryoglobulins, Hep B/C, HIV status
IVIG dosing including infusion time?
2 GRAMS/kg/cycle infused over 4-5 hrs; divided into 3 equal doses on 3 consecutive days
400 mg/kg/day for 5 days as one cycle
given mostly as half life is 3-5 weeks
how do you discontinue IVIG?
taper by increasing time interval by 2 weeks at a time: Q 4 weeks, then Q6, 8, … until 16 weeks then d/c
what is the rationale for ordering Ig levels?
to assess IgA levels, which can predict anaphylaxis (if deficiency may have anti-IgA antibodies -> anaphylaxis)
