Guidelines for Safe Use of IVIG (Intravenous Immunoglobulin)

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Guidelines for Safe Use of IVIG (Intravenous Immunoglobulin)

(September 29, 2003)

D. Lockshin, MD

Attending Rheumatologist

Professor of Medicine, Weill Medical College of Cornell University

Director, Barbara Volcker Center for Women and Rheumatic Disease

Lawrence J. Kagen, MD

Attending Rheumatologist, Hospital for Special Surgery,

Professor of Medicine, Weill Medical College of Cornell University

Leff, RN,

Nurse Manager, Infusion Unit, Hospital for Special Surgery

What is IVIG?

Intravenous immunoglobulin (IVIG, also called intravenous gamma

globlulin or IVGG) is a product derived from human blood that has been

pooled from many donors. Plasma from approximately 1,000 to 10,000

persons is present in each unit or " lot " of IVIG. The active ingredient

is immunoglobulin G (also known as IgG or gamma globulin).

IgG is one of five types of antibodies normally made by the body to

fight infection. (The other four types, for historical reasons not named

sequentially, are IgM, IgA, IgD, and IgE.) Each of the antibody types

has a special role to play in the body. IgG is the long-lasting antibody

that maintains control over infections -- after the body has fought its

initial, messy battles with invading bacteria or viruses. A small but

important part of an otherwise normal population is born without IgA, a

potential problem for treatment with IVIG (see below).

What is IVIG used for?

IVIG is approved by the FDA for use in the treatment of the following

diseases: Kawasaki disease, dermato/polymyositis, idiopathic

thrombocytopenic purpura (ITP), Guillain-Barre syndrome, polyneuropathy,

some viral diseases, and some forms of immune deficiency. IVIG is often

the first treatment choice for patients with Kawasaki disease or ITP.

For other diseases, it is used after other forms of treatment have

failed.

In addition, IVIG appears to work in systemic lupus erythematosus,

antiphospholipid syndrome, vasculitis, multiple sclerosis, myaesthenia

gravis, and a wide range of other diseases characterized by abnormal

immunity. In these cases, particularly because IVIG is very expensive,

it is usually necessary to obtain approval from your insurer before the

drug can be prescribed. (Again, IVIG is usually used in these diseases

only after other forms of treatment have failed.)

To read the entire article, please see:

http://rheumatology.hss.edu/pat/specinfo/sideeffects/ivig_use.asp

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Mayo Clinic in Rochester

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