ITP Treatments

Immunoglobulin

IVIg (Intravenous Infusion of Immunoglobulins)

IVIG is a solution of globulins containing antibodies normally present in adult human blood. Globulins are simple proteins that provide immunity against disease. A protein is made up of several amino acids, which are the microscopic building blocks that make up all cells. IVIG is used as a temporary treatment to elevate platelet counts. Administration every 10 to 21 days is usually required to maintain adequate platelet counts. Response to treatment is usually seen in 8 days.

Each batch of IVIg is made of human plasma derived from pools of 3,000 to 10,000 donors. Because this product is developed from pooled blood samples of many different donors, it is theoretically possible that viruses or bacteria could be transmitted in the product. Since 1985, however, all products are tested for HIV and hepatitis. Immune Globulin comes in sterile solution and is administered intravenously. It is made in different strengths and sizes.

Dosage

The therapeutic dose of IVIg is set at 2 g/kg. Although some practitioners divide the total dose for infusion into five daily doses of 400 mg/kg each, it may be preferable to divide the total dose into two daily doses of 1 g/kg each, provided that the patient does not have such underlying conditions as congestive heart failure or renal (kidney) insufficiency.

Cost

The cost for immunoglobulin has increased dramatically in the last few years.  The cost varies with the supplier and the delivery setting.  You can receive IVIg infusions in a hospital, doctor's office or at home.

Side Effects

In general, adverse reactions to IVIg therapy are usually minor and occur in no more than 10% of patients. Mild-to-moderate headache, which responds to nonsteroidal anti-inflammatory drugs, is common. Chills, chest discomfort may develop in the first hour of the infusion and usually respond to cessation of the infusion for 30 minutes and resumption of it at a slower rate. Fatigue, fever, or nausea may occur after infusion and may last as long as 24 hours. Other side effects include, dizziness, leg cramps, muscle aches and pains and pain and tenderness at the injection site. Side effects that should be reported to a health care provider includes, difficulty breathing, shortness of breath, wheezing, chest pain or tightness, seizures or convulsions. A severe anaphylactic reaction may occur in patients who have a serious deficiency of IgA associated with anti-IgE or anti-IgG antibodies against IgA, which react with the IgA in the IGG preparation. The reaction is rare occurring in about 1 out of 1000 people.

Related Web Sites

• General IVIg information from Bayer
• Baxter - Gammagard and Iveegam
• IgG America - Home Infusion Service
• http://www.ssem.com/gammagard/settlement/notice/gammagard.html
• http://text.nlm.nih.gov/nih/cdc/www/80txt.html
• http://www.scid.net/other.html The SCID Home Page (Severe Combined Immunodeficiency)