Guidelines for the Use of Intravenous Immune Globulin for Hematologic and Neurologic Conditions

Abstract

From Canadian Blood Services; and the National Advisory Committee on Blood and Blood Products. E-mail: heather.hume@blood.ca 0887-7963/07/$ see front matter n 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.tmrv.2007.01.003 THIS SUPPLEMENT OF TransfusionMedicine Reviews is devoted to the publication of 2 sets of guidelines, developed in Canada in 2004–2006, for the use of intravenous immune globulin (IVIG). Since 1997–1998, IVIG use in Canada has increased dramatically—by approximately 115%—from 47 g per 1000 population in 1998 to 101 g per 1000 population in 2005–2006, with Canada now having one of the highest per capita uses of IVIG worldwide. This has occurred in the absence of any recent changes in the licensed indications for IVIG and is also accompanied by wide variations in per capita use among Canadian provinces. In a few cases, this increase in IVIG use reflects the appropriate application of results of recently conducted randomized controlled trials—for example, in some neurologic conditions (as reviewed in detail in one of the guidelines published in this supplement). However, in other cases, this has occurred in the absence of solid evidence for its effectiveness in the given clinical setting. The reasons for this increase in the absence of published evidence are likely a combination of several factors, including the severity of the diseases and lack of effective treatment alternatives in the clinical settings in which it is used, the relative ease of IVIG administration, the low frequency of serious adverse effects associated with IVIG, the absence of recent supply restraints, and the funding mechanism within Canada. Although it is indeed true that IVIG has a remarkably good safety record, particularly