Hematologic toxicities associated with intravenous immunoglobulin therapy

Baxley, Allison; Akhtari, Mojtaba

doi:10.1016/j.intimp.2011.07.024

Cited by 33 publications

(34 citation statements)

References 50 publications

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“…Since the 1980s, there have been reports of serious IVIg-associated adverse TEEs, including acute myocardial infarction (AMI), ischemic stroke, and venous thromboembolism. [8][9][10] Between 2006 and 2010, 209 TEEs associated with immune globulin treatment were reported via the FDA Adverse Events Reporting System. 10 IVIg-associated TEE reports led to the voluntary withdrawals of the IVIg products Octagam from the US market in 2010 and Omr-IgG-am from the Israeli market in 2011.…”

Section: Introductionmentioning

confidence: 99%

Intravenous immune globulin and thromboembolic adverse events in patients with hematologic malignancy

Ammann¹,

Jones

Link

et al. 2016

Blood

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Section: Introductionmentioning

confidence: 99%

Intravenous immune globulin and thromboembolic adverse events in patients with hematologic malignancy

Ammann¹,

Jones

Link

et al. 2016

Blood

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“…There is passive transfer of anti-A and anti-B hemagglutinins, because these hemagglutinins are not removed during the manufacture of IVIG. The antibodies that are present in IVIG preparations can coat the recipient's RBCs and cause hemolysis (22)(23)(24)(25)(26). As illustrated in Figure 7, the amount of anti-A and anti-B varies in different IVIG preparations (26) Our patient's blood type is AB, making his RBCs a target for antibodies to both blood groups A and B antigens.…”

Section: Discussion Of Case 2 Question 2bmentioning

confidence: 99%

“…With intravascular hemolysis implicated, considerations in our patient's history for the underlying cause include rejection, IVIG, infection, and sirolimus. IVIG is pooled from approximately 1000 donors who encompass all blood types (22). Donors with type O blood can contribute blood group antibodies directed against A and B blood group antigens, donors with type B blood can provide antibodies to blood group A, and donors with type A blood can contribute antibodies to blood group B.…”

Section: Discussion Of Case 2 Question 2bmentioning

confidence: 99%

American Society of Nephrology Quiz and Questionnaire 2013

Josephson

Perazella

Choi

2014

Clinical Journal of the American Society of Nephrology

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The nephrology quiz and questionnaire remains an extremely popular session for attendees of the Annual Meeting of the American Society of Nephrology. As in past years, the conference hall was overflowing with interested audience members. Topics covered by expert discussants included electrolyte and acid-base disorders, glomerular disease, ESRD/dialysis, and transplantation. Complex cases representing each of these categories along with single best answer questions were prepared by a panel of experts. Before the meeting, program directors of United States nephrology training programs answered questions through an Internet-based questionnaire. A new addition to the nephrology quiz and questionnaire was participation in the questionnaire by nephrology fellows. To review the process, members of the audience test their knowledge and judgment on a series of caseoriented questions prepared and discussed by experts. Their answers are compared in real time using audience response devices with the answers of nephrology fellows and training program directors. The correct and incorrect answers are then briefly discussed after the audience responds, and the results of the questionnaire are displayed. This article recapitulates the session and reproduces its educational value for the readers of CJASN. Enjoy the clinical cases and expert discussions.

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“…Aseptic meningitis has also been reported as an IVIg-related adverse event; however, it is usually mild and resolves without sequelae [72]. PRES may occasionally occur after IVIg infusion [73,74].…”

Section: Safety Considerationsmentioning

confidence: 99%

“…In such cases, improvement was reported with PE therapy [75,76]. Other possible side effects include vasospasm, vasculitis, enterocolitis, eczema, hyperproteinemia, hyponatremia, and mild leukopenia [72]. IVIg is a plasma product and, therefore, has the inherent potential risk of transmission of different infectious agents, such Parvovirus B19 or the prion protein; however, no cases of the latter have so far been reported [77].…”

Section: Safety Considerationsmentioning

confidence: 99%

Intravenous immunoglobulin: pharmacological properties and use in polyneuropathies

Dézsi

Horváth

Vécsei

2016

Expert Opinion on Drug Metabolism & Toxicology

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 This review includes a description of the composition, pharmacokinetics, and mechanisms of action of IVIg. The second part of the paper provides an overview of the immune-mediated polyneuropathies in which IVIg is a first-line therapy, with special focus on the pathomechanism of the diseases, the mechanisms of action of IVIg, and of the main results of clinical trials supporting the evidence of its efficacy. Composition of IVIgIVIg is a complex preparation pooled from a minimum of 1000 and up to 60,000 donors, [6,7]. The anti-idiotypes can block the antigen-binding site of the pathological antibody.IVIg preparations contain many idiotypes and antibodies against several receptors as well. See Table 2 for details [8,9].At first, IVIg was used in a concentration of 5%, but subsequently, formulations with higher concentrations of 10-12% were also developed, which permitted the lowering of the volume load and the shortening of the time of administration. Formulations for subcutaneous use (SCIg) are available since the 1980s, which permit steadier IgG levels and a more favorable systemic side effect profile, except for the higher incidence of local reactions. Several brands of IVIg are available, with each considered to be a distinct product with a unique composition and different excipients. The products differ with regard to the production process, viral inactivation, purification, IgA content, sodium content, and the applied stabilizers, and are associated with different risks of adverse effects, depending predominantly on the IgA content, the osmolarity, and the stabilizers used.In recent years, significant advances have been achieved in the production process of IVIg preparations with regard to purity, pathogen inactivation, and stabilization. Cold alcohol fractionation is used to isolate the immunoglobulin-containing plasma fraction, which is further purified through multiple steps of precipitation and can also be combined with ionexchange chromatography, processes resulting in a highly purified polyvalent IgG product 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 PharmacokineticsThe dose of IVIg used for the treatment of immunodeficient conditions is 0.4-0.6 g/kg, administered every 3 to 4 weeks. Once the diagnosis is set, a continuous replacement therapy is to be initiated, which should not be interrupted. Some patients require higher doses of up to 0.8 g/kg. Doses exceeding this level have not been evaluated [13]. The total dose used in autoimmune/inflammatory diseases is 2 g/kg, administered in 2-5 consecutive days. This dose was introduced to clinical practice after the observation of a dramatic increase ...

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Hematologic toxicities associated with intravenous immunoglobulin therapy

Cited by 33 publications

References 50 publications

Intravenous immune globulin and thromboembolic adverse events in patients with hematologic malignancy

Intravenous immune globulin and thromboembolic adverse events in patients with hematologic malignancy

American Society of Nephrology Quiz and Questionnaire 2013

Intravenous immunoglobulin: pharmacological properties and use in polyneuropathies

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