Intraveous immunoglobulins in clinical practice

Intravenous immunoglobulin (IVIG) replacement is indicated for the prevention of infection in patients with antibody deficiency. This may be primary or secondary, as in some cases of myeloma. Immunological adverse reactions are increased if acute infection is present.

IVIG should be deferred for 24-48 hours and antibiotics commenced. With adequate immunoglobulin replacement serious infections and progression to chronic disease such as bronchiectasis is prevented. However, patients often present late and will benefit even in the presence of suppurative lung disease.

Hepatitis C outbreaks have been associated with IVIG, although modern production methods minimise this risk. Acute renal failure has been associated with IVIG, particularly in older people with pre-existing renal disease, as may occur in myeloma. IVIG should be used with caution in these people but is not contraindicated.

Reference

• Lee ML, Strand V. Intraveous immunoglobulins in clinical practice. New York: Marcl Dekker, 1997.