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Patients with high blood pressure and/orheart, lung, or kidney
disease may experience a
worsening o blood pressure or an accumulationo uid in the body
leading to shortness o breathor chest discomort. Proper choice o
dose andinusion rate should minimize this risk.
What other risks are there?
Being a human product made rom blooddonations by many people,
IVIG can transmitdisease. IVIG available in the United States
isvery careully screened to be ree o all knowntransmissible
diseases, including HIV, hepatitis,malaria, syphilis, and many,
many others.However, as with blood transusions, there isalways a
risk that the product contains an inectionthat has not yet been
recognized either becauseit is a previously unknown disease or
because adonors inection was in such an early stage thathis or her
blood gave no clues.
o put this in perspective, American bloodproducts are the saest
in the world. Very, veryew people have ever gotten an inection
romIVIG. However, in the past 30 years, IVIG hasbeen temporarily
removed rom the market threetimes each time to test it or a newly
recognizeddisease (HIV, hepatitis C, mad-cow disease)that had not
been excluded beore the IVIG had
been released to the public. In act, IVIG did notcarry these
diseases and no one actually got sickbecause o having received
IVIG. However, no onecan guarantee that a new disease will not
appeartomorrow that has not yet been tested or.
How does IVIG work?
It is not clear how IVIG works. Tere are severaltheories.
Most physicians believe that IVIG likelysends a signal to an
immune system that is in
overdrive to slow down. Tus, it may shut downautoimmune diseases
like IP, polymyositis,vasculitis, and others.
It may provide antibodies, present in the bloodo normal donors,
that the patient lacks.
Another theory is that IVIG supplies a decoytarget or an
overactive immune system to attack.Tus it diverts the abnormal
immune systemrom the bodys normal organs.
Whichever theory is correct, it is undeniable thatIVIG does
work. For many patients, IVIG is thesaest and most easily tolerated
treatment available.
IVIG is inused in the transusion unit at Hospitalor Special
Surgery.
Hospital or Special SurgeryBarbara Volcker Center or
Women and Rheumatic Disease
For more inormation, please visit:www.hss.edu
Tel: 212.606.1461
Fax: 212.774.2374
Email: [email protected]
Barbara Volcker Center
for Women andRheumatic Disease
INTRAVENOUS
IMMUNOGLOBULIN(IVIG)
Tis brochure was provided to you by theAPS Foundation o America,
Inc. withpermission rom Hospital or Special Surgeryand the Barbara
Volcker Center or Women andRheumatic Disease.
www.apsfa.org
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A simple blood test done beore the inusion willdetermine i you
do not have IgA.
When IVIG is owing into a vein, it puts a
moderately severe strain on the heart, lungs andkidneys. It has
to be given very cautiously topeople who have problems with these
organs. Forthis reason, IVIG can be given only in an inusionunit or
in a hospital where you will be monitored.
IVIG will prevent vaccinations rom taking.So, i possible, you
should not receive IVIG
within a month ollowing an immunization. Andimmunizations should
not be given or at least 1month preerably 3 months ater a course
o
IVIG.
What side efects can I expect?
It is airly common or patients to experienceheadache (which can
range rom mild to severe), asti neck, and sometimes ever, during or
shortlyater an inusion. (Tis is called aseptic meningitissyndrome.)
Tese symptoms can be minimized orprevented by inusing IVIG very
slowly. I theyoccur during the inusion, slowing the inusion
rate is oten sucient to make them go away.Patients oten eel
atigued on the day ater theinusion.
Sometimes physicians not amiliar with the useo IVIG may mistake
the headache or inectiousmeningitis, which it is not. So it is
important thatany other physician who is treating you and whomay be
concerned about new symptoms consult
with the physician who is prescribing your IVIG.Te physician who
is prescribing your IVIG will
be ully inormed about its possible side eects andhow to handle
them.
characterized by abnormal immunity. In thesecases, particularly
because IVIG is very expensive,it is usually necessary to obtain
approval rom your
insurer beore the drug can be prescribed. (Again,IVIG is usually
used in these diseases only aterother orms o treatment have
ailed.)
How is IVIG given?
IVIG is given intravenously (dripping liquid slowlythrough a
vein) over several hours. Te treatmentis usually repeated or 2 to 5
days. Further, itmay be repeated at 1 to 3 month intervals until
asatisactory response is obtained.
Body weight and specifcs o illness determinethe actual dosage.
For instance, a common doseregimen is 0.2-0.4 grams o IVIG per
kilogram opatient weight or 4 consecutive days, to a total o2
grams/kilogram (0.7 grams/pound). For a 144pound person (the
typical 70 kilogram man), this
would translate to 140 grams, dissolved in saltwater.
Te inusion time will also vary depending on theamount given per
day and the persons tolerance.
Your inusion rate will start slowly and graduallyincrease over
the course o the inusion. A typicalinusion o IVIG can take several
hours.
Who should not take IVIG?
Persons born without IgA (one o the 5immunoglobulins) are very
likely to develop anallergic reaction to IVIG, which contains a
smallamount o IgA; generally, such persons cannotbe treated with
IVIG. Even persons with normal
amounts o IgA can develop an allergic reactionto IVIG and may
not be able to take the product.
What is IVIG?
Intravenous immunoglobulin (IVIG, also calledintravenous gamma
globlulin or IVGG) is a product
derived rom human blood that has been pooledrom many donors.
Plasma rom approximately1,000 to 10,000 persons is present in
eachunit or lot o IVIG. Te active ingredient isimmunoglobulin G
(also known as IgG or gammaglobulin).
IgG is one o fve types o antibodies normally madeby the body to
fght inection. (Te other our types,or historical reasons not named
sequentially, areIgM, IgA, IgD, and IgE.) Each o the antibody
types has a special role to play in the body. IgG isthe
long-lasting antibody that maintains controlover inections ater the
body has ought itsinitial, messy battles with invading bacteria
orviruses. A small but important part o an otherwisenormal
population is born without IgA, a potentialroadblock or treatment
with IVIG (see below).
What is IVIG used or?
IVIG is approved by the FDA or use in the
treatment o the ollowing diseases: Kawasakidisease,
dermato/polymyositis, idiopathicthrombocytopenic purpura (IP),
Guillain-Barresyndrome, polyneuropathy, some viral diseases,
andsome orms o immune defciency. IVIG is otenthe frst treatment
choice or patients with Kawasakidisease or IP. For other diseases,
it is used aterother orms o treatment have ailed.
In addition, IVIG appears to work in patients withsystemic lupus
erythematosus, antiphospholipid
syndrome, vasculitis, multiple sclerosis, myaestheniagravis, and
a wide range o other diseases
INTRAVENOUS IMMUNOGLOBULIN (IVIG)
