Intravenous Immunoglobulin

Concentrated immunoglobulin produced by pooling fractionated plasma from thousands of healthy donors, providing a rich and diverse mix of antibodies.

Indications

Broadly either:

  • Humoral immune deficiency
    • Primary
    • Acquired
  • General immunomodulation
    Trialled in a wide variety of diseases, with established evidence for:
    • ITP
    • Kawasaki disease
    • GBS
    • Dermatomyositis

Mechanism

IVIG contains:

  • >95% IGG
  • Trace IgA
  • Trace IgM
  • Cytokines
  • CD4
  • CD8
  • HLA molecules

These have a variety of immunomodulatory an anti-inflammatory effects:

  • Modulated complement activation
  • Inhibited membrane attack complex
  • Antibody suppression
  • Super-antigen neutralisation
  • Macrophage Fc receptor saturation

Equipment

Technique

Complications

Inflammatory adverse effects:

  • Are common (3-8%)
  • Include:
    • ↑ HR
    • ↓ BP
    • Flushing
    • Fever
    • Headache
    • Fatigue
    • Nausea
    • Diarrhoea
  • Are managed supportively:
    • Ceasing or slowing the infusion
    • Symptomatic
      • Analgesics
      • Antihistamines
    • Glucocorticoids

Severe adverse effects:

  • Are rare
  • Occur late
  • Include:
    • Aseptic meningitis
    • AKI
    • VTE
    • Neutropenia
    • Haemolysis
    • Arthritis

References

  1. Bersten, A. D., & Handy, J. M. (2018). Oh’s Intensive Care Manual. Elsevier Gezondheidszorg.