II. Indications: FDA Approved
- Idiopathic Thrombocytopenic Purpura
- Bone Marrow Transplant
- Primary Humoral Immunodeficiency
- Chronic Lymphocytic Leukemia (B Cell)
- Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)
- Kawasaki Disease
- Pediatric HIV
III. Indications: Off-Label (non-FDA approved)
IV. Contraindications
- IgA Deficiency
- Caution in conditions with higher risk of adverse effects
- Thrombotic conditions (including Thrombophilia)
- Congestive Heart Failure
- Renal Insufficiency
V. Mechanism
- Pooled donor plasma extracted for IgG antibodies and administered as an intravenous Blood Product
VI. Dosing
- Precautions
- Caution in patients with thrombotic conditions, Congestive Heart Failure and Renal Insufficiency
- Consider pretreatment with Acetaminophen, Diphenhydramine to reduce infusion reaction symptoms
- Infuse at lowest possible rate of the lowest available concentration (minimize risk of adverse effects)
- Initial Infusion Rate at 0.5 mg/kg/min (0.005 mL/kg/min)
- Subsequent infusion rates as tolerated up to 4 to 8 mg/kg/min (0.04 to 0.08 mL/kg/min)
- Primary Humoral Immunodeficiency
- Adult or Child: 200 to 300 mg/kg (up to 400 to 800 mg) IV monthly
-
Idiopathic Thrombocytopenic Purpura (Induction Dose)
- 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)
- Adult Pre-BMT: 500 mg/kg IV on day 7 and day 2 before BMT
- Adult: Post: BMT: 500 mg/kg IV weekly for 90 days after BMT
-
Kawasaki Disease
- Infuse 400 mg/kg IV daily for 4 days (or 2000 mg/kg IV once over 10 hours)
- Other dosing regimens vary by indication
- See other references and specific condition guidelines for up to date dosing regimens
VII. Adverse Effects
- Thrombosis (black box warning)
- Caution in Hypercoagulable states and cardiovascular disease
- Infuse at lowest possible rate of the lowest available concentration
-
Acute Kidney Injury or Renal Failure (Black Box warning)
- Kidney injury is more common with sucrose containing solutions
- Caution with concurrent Nephrotoxic Drugs, Chronic Kidney Disease
- Infuse at lowest possible rate of the lowest available concentration
- Fluid and Electrolyte Abnormalities
- Hyperproteinemia
- Hyponatremia
-
Hemolytic Anemia
- Intravascular Hemolysis or RBC sequestration
- Increased risk with high IVIG doses and Non-O Blood Group
- Cardiopulmonary
- Bloodborne Communicable Disease
- As with all donor Blood Products, carefully screened in U.S., but risk is not 0%
- Potential risk of Creutzfeldt Jakob Disease (or its variant)
- Other common effects
VIII. Safety
- Pregnancy Category C
- Unlnown safety in Lactation
- Monitoring
IX. Resources
- Arumugham and Rayi (2023) Intravenous Immunoglobulin (IVIG) , StatPearls, Treasure Island, Florida
- Intravenous Immunoglobulin - Privigen (DailyMed)
- Intravenous Immunoglobulin - Gamunex (DailyMed)
- Intravenous Immunoglobulin - Gammagard (DailyMed)
- Intravenous Immunoglobulin - Alyglo (DailyMed)
- Intravenous Immunoglobulin - Octagam (DailyMed)