Intravenous Immunoglobulin

IgA Deficiency
Caution in conditions with higher risk of adverse effects
1. Thrombotic conditions (including Thrombophilia)
2. Congestive Heart Failure
3. Renal Insufficiency

Pooled donor plasma extracted for IgG antibodies and administered as an intravenous Blood Product

Precautions
1. Caution in patients with thrombotic conditions, Congestive Heart Failure and Renal Insufficiency
2. Consider pretreatment with Acetaminophen, Diphenhydramine to reduce infusion reaction symptoms
3. Infuse at lowest possible rate of the lowest available concentration (minimize risk of adverse effects)
  1. Initial Infusion Rate at 0.5 mg/kg/min (0.005 mL/kg/min)
  2. Subsequent infusion rates as tolerated up to 4 to 8 mg/kg/min (0.04 to 0.08 mL/kg/min)
Primary Humoral Immunodeficiency
1. Adult or Child: 200 to 300 mg/kg (up to 400 to 800 mg) IV monthly
Idiopathic Thrombocytopenic Purpura (Induction Dose)
1. Adult or Child: 400 mg/kg IV daily for 5 days (or 1000 mg/kg IV daily for 1-2 days)
Bone Marrow Transplant (BMT, age >=20 years)
1. Adult Pre-BMT: 500 mg/kg IV on day 7 and day 2 before BMT
2. Adult: Post: BMT: 500 mg/kg IV weekly for 90 days after BMT
Kawasaki Disease
1. Infuse 400 mg/kg IV daily for 4 days (or 2000 mg/kg IV once over 10 hours)
Other dosing regimens vary by indication
1. See other references and specific condition guidelines for up to date dosing regimens

Thrombosis (black box warning)
1. Caution in Hypercoagulable states and cardiovascular disease
2. Infuse at lowest possible rate of the lowest available concentration
Acute Kidney Injury or Renal Failure (Black Box warning)
1. Kidney injury is more common with sucrose containing solutions
2. Caution with concurrent Nephrotoxic Drugs, Chronic Kidney Disease
3. Infuse at lowest possible rate of the lowest available concentration
Fluid and Electrolyte Abnormalities
1. Hyperproteinemia
2. Hyponatremia
Hemolytic Anemia
1. Intravascular Hemolysis or RBC sequestration
2. Increased risk with high IVIG doses and Non-O Blood Group
Cardiopulmonary
1. Hypertensive Urgency
2. Transfusion-Related Acute Lung Injury (TRALI)
Bloodborne Communicable Disease
1. As with all donor Blood Products, carefully screened in U.S., but risk is not 0%
2. Potential risk of Creutzfeldt Jakob Disease (or its variant)
Other common effects
1. Headache
2. Nausea or Vomiting
3. Fever or chills