Patient education: Intravenous immune globulin (IVIG) (Beyond the Basics)
- Arthur J Silvergleid, MD
Arthur J Silvergleid, MD
- Section Editor — Transfusion Medicine
- Affiliate Associate Professor, Department of Pathology and Cell Biology
- University of South Florida, College of Medicine
- Medical Director, OneBlood, Inc.
WHAT IS IVIG?
Intravenous immune globulin ("IVIG") is a product made up of antibodies that can be given intravenously (through a vein).
Antibodies are proteins that your body makes to help you fight infections. Each antibody made by your body is slightly different, because it fits like a lock and key to every foreign substance (such as a virus) that gets into your body. This is why you need a new flu shot every year; each year the flu virus is slightly different, and different antibodies (which the vaccine causes your body to produce) are required to protect you. Over the course of your life your body makes thousands of different antibodies. IVIG is prepared from the blood donated by thousands of people, to make a super-concentrated collection of antibodies against many possible foreign substances your body might encounter.
WHY DO I NEED IVIG?
IVIG is used primarily in two situations.
One reason you might need IVIG is if your body does not make enough antibodies. Another name for this is humoral immunodeficiency. The IVIG simply provides extra antibodies that your body cannot make on its own. The antibodies usually last for several weeks and help your body fight off a large variety of infections. If you are getting IVIG for this reason, you will need to get it on a regular schedule.
A second reason you might need IVIG is if your immune system has started attacking your body's normal cells. Common examples of conditions in which this happens include:
●Immune system destruction of your own blood platelets (medical name: immune thrombocytopenia [ITP])
●Immune destruction of your own red blood cells (medical name: autoimmune hemolytic anemia [AIHA])
●Immune attack on your nervous system, such as nerves that control your breathing (in Guillain-Barré syndrome) or nerves that control sensation as in certain neuropathies
In this second case, it is not completely known how the IVIG works. Experts believe it does a combination of things, including preventing the abnormal antibodies directed against your own cells from working and preventing immune cells from being as active.
HOW IS IVIG GIVEN?
IVIG is given into a vein ("intravenously"), in an infusion that takes one hour or more. The amount of IVIG you need for each dose depends on your weight as well as the reason you are getting the IVIG:
●If you need IVIG to replace the antibodies your body should be producing, you need less IVIG, but you need to continue to receive it on a regular basis. Your doctor will determine how often you need the infusions, and how long you will need to continue to get them (this may need to be re-evaluated periodically).
●If you need IVIG to block your immune system from attacking your own cells, you need more IVIG in a single dose, but you generally don't need too many doses. If the IVIG is going to work, your doctor can usually tell after one or a few doses.
IVIG usually is given in a doctor's office or hospital. In some cases, it can be given in the home, if proper arrangements are made.
IVIG SIDE EFFECTS
Many people do not have side effects from IVIG, but there are a lot of possible side effects, especially if you are not receiving the IVIG on a regular basis and/or if you are receiving larger doses of IVIG. However, over the course of their treatment, up to half of people may experience one side effect, usually minor or bothersome but not dangerous. Very rarely, more serious side effects like allergic reactions or blood clots can occur.
Side effects that can happen right away include chills, fever, flushing, flu-like muscle pains or joint pains, feeling tired, having nausea, vomiting, headache, and allergic-type reactions. For the most part, these reactions are mild and typically happen with the first dose of IVIG or if you change to a different brand of IVIG.
Side effects that can happen after a day or more include blood clots, headaches, rashes, kidney problems, and low blood counts.
Your doctor may do several things to reduce the chance of having these side effects, including:
●Performing certain blood tests before the IVIG is started
●Keeping you well hydrated, in some cases giving extra fluids (by mouth or intravenously)
●Sometimes giving the infusion more slowly
●Dividing a large dose into several smaller doses that are given over several days
●Giving you pain-relieving medications prior to your infusion – These may include acetaminophen (sample brand name: Tylenol); a non-steroidal anti-inflammatory drug or "NSAID" such as ibuprofen (sample brand names: Advil, Motrin) or naproxen (sample brand name: Aleve); or glucocorticoids. However, many people do not require these medications before the IVIG is given.
●Minimizing the risk of blood clots – Some patients may be given a medicine like aspirin to help prevent blood clots. Your doctor may also advise you not to sit still for long periods of time (for example, on an airplane flight) in the day or two following the infusion.
Some people worry about contracting a disease through IVIG, since it is made from blood donated by other people. The risk of getting a viral infection from IVIG is considered exceedingly low. No one has ever gotten HIV (the virus that causes AIDS) from IVIG, and the methods used to purify IVIG will destroy bacteria, hepatitis viruses, and other infectious organisms. However, no one can predict every new infection that may develop. This is the reason IVIG is only given when it is really needed and records of the specific IVIG lot number are kept.
ARE THERE ANY ALTERNATIVES TO IVIG?
If you are receiving IVIG to provide extra antibodies, the two major alternatives are immune globulin given subcutaneously (as an injection under the skin) or intramuscularly (as an injection into a muscle). Subcutaneous immune globulin (SCIG) has fewer side effects and may be a good option for some people. Since you get a smaller amount, this usually applies to people who are getting the treatment to give the body's immune system extra antibodies to fight infections.
If you are receiving IVIG to block your immune system from damaging some of your own cells, there are several alternative medicines that can control your immune system.
●Commonly used medicines to block the immune system include glucocorticoids like prednisone and dexamethasone or certain medicines like rituximab (brand name: Rituxan). However, these medicines often take several days or weeks to work, so IVIG may be a good option if you need a treatment that works rapidly.
●Plasmapheresis (filtering your blood, also called plasma exchange) may also be an option.
●Another form of antibodies is called Rh(D) immune globulin (sample brand name: RhoGam); this is the form of antibodies given to some pregnant women to prevent problems related to the baby having a different blood type from the mother. Rh(D) immune globulin contains antibodies directed against some proteins on red blood cells and can sometimes make you anemic.
IS THERE ANYTHING ELSE I NEED TO KNOW?
Vaccines may not work as well in the days directly after the IVIG is given, because the IVIG may block the immune system from responding appropriately to the vaccine. However, it is important to get certain vaccines, and you are better protected if you get the vaccines than if you do not. Discuss the best timing with your doctor.
Keep records of the lot number and date you received your IVIG infusions. This is important for keeping track of which products worked best for you and for testing if you think you had a side effect related to the IVIG.
If a specific brand of IVIG is working well for you, it is safer not to substitute a different brand.
WHERE TO GET MORE INFORMATION
Your healthcare provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.
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