Dose Of Intravenous Immune Globulin Research Articles

Immunoprophylaxis against Bacterial Infection in the Intensive-Care Unit

Patients (n = 1,392) admitted to the intensive-care unit were randomized to receive either 100 mg/kg intravenous immune globulin (IVIG) hyperimmune to <i>Klebsiella </i>spp. and <i>Pseudomonas aeruginosa </i>or an albumin placebo. There was no difference in the overall mortality rates between the two groups. The incidences of infections due to <i>Klebsiella </i>spp. and gram-positive bacteria were reduced in the IVIG group. The incidence of <i>P. aeruginosa </i>infections was not affected. Administration of IVIG completely prevented <i>Klebsiella </i>bacteremia and reduced the incidence of severe <i>Klebsiella </i>infections. Patients receiving IVIG had a higher incidence of adverse reactions than the placebo group. There was a trend towards a reduced infection rate for both <i>Klebsiella </i>spp. and <i>P. aeruginosa </i>with increasing specific-antibody levels. Therefore, a second trial has been initiated in which the dose of IVIG has been increased to 300 mg/kg.

DOES HIGH-DOSE INTRAVENOUS IMMUNE GLOBULIN TREATMENT AFTER BONE MARROW TRANSPLANTATION INCREASE MORTALITY IN VENO-OCCLUSIVE DISEASE OF THE LIVER?

Forty-five recipients of bone marrow from HLA-identical siblings were given intravenous immune globulin (IVIG) 0.5 g/kg once a week during the first 3 months after transplantation. Fifty-three consecutive previously transplanted HLA-identical siblings were included as controls. Only patients who were cytomegalovirus (CMV) seropositive or had a CMV-seropositive donor were included. There were no major differences in patient characteristics between the two groups. However, more patients in the IVIG group received individualized graft-versus-host disease (GVHD) prophylaxis with less cyclosporine (P < 0.01), more controls received liposomal amphotericin B (P = 0.01), and more patients in the IVIG group received low-dose heparin as prophylaxis against veno-occlusive disease of the liver (P < 0.001). Median follow-up was 21 months in the IVIG group and 47 months in the control group. There were no differences between the groups with regard to time to engraftment, hospitalization time, or days with fever. No differences between the IVIG group and control group were detected in the incidence of acute GVHD grade II-IV (17% vs. 23%) or chronic GVHD (30% vs. 42%). The incidence of bacterial septicemias (53% vs. 63%) and invasive fungal infections (9% vs. 6%) was unaffected by IVIG treatment. The incidence of symptomatic CMV infection was the same in the two groups (14% vs. 16%). One control patient died of CMV interstitial pneumonitis, and 1 patient from each group died from viral interstitial pneumonitis of other origin. The incidence of veno-occlusive disease (VOD) was 16% in the IVIG group versus 6% in the controls (P = NS). Fatal VOD occurred in 11% of the IVIG group compared with none of the controls (P = 0.02). Other transplant-related complications did not differ between the two groups. Two-year survival was 62% in the IVIG group and 60% in the controls (P = NS). No significant beneficial effect was seen with IVIG, which may increase mortality in VOD. The use of high dose IVIG as prophylaxis in marrow transplant recipients is questioned.

Hepatitis A Virus Transmission by Blood Products in the United States

To address the question of HAV prevalence and seroconversion in relation to clotting factor concentrates, we assayed an early serum for 339 hemophiliacs followed every 6 months by the Transfusion Safety Study in the period from mid-1985 until mid-1992. We found 58.4% positive around entry, with an age-specific prevalence that did not vary with age. In comparison to rates for anti-HIV-negative blood donors, they were significantly higher. Based on testing of subsequent sera, 11 hemophiliacs (7.8% of 141 susceptibles) changed their anti-HAV status from negative to positive. In 9 instances, positivity immediately followed the first dose of intravenous immune globulin. A possible seroconversion followed treatment with blood components, and a possible seroconversion followed intermediate-purity, solvent/detergent(SD)-treated factor VIII concentrate. Neither of these 2 patients was anti-HAV IgM positive, so that passively transferred antibody is possible. The high prevalence among hemophiliacs at entry must be further investigated by determining the expected background rate in a US population similar to the hemophilia patients, and by comparing anti-HAV prevalence associated with SD-treated and heat-inactivated concentrates.

Hepatitis A Virus Transmission by Blood Products in the United States

To address the question of HAV prevalence and seroconversion in relation to clotting factor concentrates, we assayed an early serum for 339 hemophiliacs followed every 6 months by the Transfusion Safety Study in the period from mid-1985 until mid-1992. We found 58.4% positive around entry, with an age-specific prevalence that did not vary with age. In comparison to rates for anti-HIV-negative blood donors, they were significantly higher. Based on testing of subsequent sera, 11 hemophiliacs (7.8% of 141 susceptibles) changed their anti-HAV status from negative to positive. In 9 instances, positivity immediately followed the first dose of intravenous immune globulin. A possible seroconversion followed treatment with blood components, and a possible seroconversion followed intermediate-purity, solvent/detergent(SD)-treated factor VIII concentrate. Neither of these 2 patients was anti-HAV IgM positive, so that passively transferred antibody is possible. The high prevalence among hemophiliacs at entry must be further investigated by determining the expected background rate in a US population similar to the hemophilia patients, and by comparing anti-HAV prevalence associated with SD-treated and heat-inactivated concentrates.

Inmunoglobulina intravenosa en el tratamiento de las polineuropatías agudas desmielinizantes

The management of acute demyelinating polineuropathy is currently a controversial issue , particularly in GuillainBarre syndrome. Nowadays the use of intravenous immune globulin (IVIG) in these patients has been proposed,given its beneficial effects upon the immune system, which seems to play a rol in the pathogenesis of thes e diseases.The clinical cases of three pediatric male patients with severe acute demyelinating polineorupathy, who were treatedwith high doses of IVIG are described. All three boys showed fast clinical relief and functional muscular activityrecovery after only a short period of assisted mechanical ventilation in the two cases in which it was indicated,including ability to walk, which recovered before fifteen days after the beg in ing of treatment.Unidad de Infecciosos, Servicio y Departamento de 3. Seivicio de PedJatn'a, Hospital Patroquial de SanPediatria y Cirugia Infantil, Hospital San Juan de Bernardo.Dios, Seivicio Salud Metropolitans Occidentc, Fa- 4. Becada. Servicio y Departamento de Pediatn'a ycultad de Medicina, Division Ciencias Medicas Occi- Cirugia Infantil, Hospital San Juan de Dios, Facul-dente, Universidad de Chile. tad de Medicina, Division Gencias Me'dicas Occiden-Servicio de Neuropsiquiatrfa Infantil, Servicio Salud te, Universidad de Chile.Metropolitano Occidente.

Treatment of interstitial pneumonitis due to cytomegalovirus with ganciclovir and intravenous immune globulin: experience of European Bone Marrow Transplant Group.

Data on 49 allogeneic bone marrow transplant (BMT) recipients who developed interstitial pneumonia due to cytomegalovirus (CMV) were collected retrospectively. All patients were treated with ganciclovir and high doses of intravenous immune globulin, although types of immune globulins and schedules of treatment varied. Seventeen (35%) of 49 patients responded to treatment. Thirty days after the diagnosis of interstitial pneumonia, the survival rate among patients was 31%. CMV was detected in 81% of patients on whom autopsies were performed. The survival rate among patients who received total body irradiation (TBI) was significantly lower (11 [27%] of 41) than that among patients who did not receive TBI (six [75%] of eight; odds ratio = 12.3; P = .009). No other factor, including age, grade of graft-versus-host disease, types and dose of immune globulin used, or dose of ganciclovir, was correlated to survival. These results show that although survival of allogeneic BMT recipients with CMV interstitial pneumonia has improved, more than one-half of the patients still died of pneumonia. Thus, both prophylaxis for and treatment of CMV infection must be improved.

A collaborative trial of a single dose of intravenous immune globulin in the treatment of Kawasaki syndrome: Earl D. Silverman, Karyl S. Barron, and the Kawasaki Working Group, The Hospital for Sick Children, Toronto, Ontario

A collaborative trial of a single dose of intravenous immune globulin in the treatment of Kawasaki syndrome: Earl D. Silverman, Karyl S. Barron, and the Kawasaki Working Group, The Hospital for Sick Children, Toronto, Ontario

ガンマグロブリン大量静注療法時に抗Ａ抗体による溶血性貧血を合併した特発性血小板減少性紫斑病（ＩＴＰ）の１症例

Here reportd a 28-year-old female patient with ITP, showing incompatible results between on the main and on the accessory test for ABO blood typing, accompanied with hemolytic anemia after receiving large doses of intravenous immune globulin (IVIG). These abnormalities were attributable to anti-A antibody derived from the immune globulin products. Her red blood cells were group A, Rh (D)-positive, and she was in the fifth month of pregnancy. Her serum reacted positively against the group A panel red blood cells; 2+ by the saline method, 3+ by the albumin method, and 1+ by the antiglobulin method. Besides, the direct anti-globulin test showed a weak positive reaction. The highest anti-A antibody titer in the immune globulin products used for her IVIG therapy were 1:8 by the saline method, and 1:512 by the anti-globulin method. Nevertheless, her anemia accompanied with low haptoglobin level, returned to the former level without blood transfusion within one week after the cessation of the IVIG. Incidence of such adverse reactions as that mentioned above may increase hereafter, as the IVIG therapy is now more and more frequently applied to the treatment of ITP.

Experimental studies of the pathogenesis of infections due to Pseudomonas aeruginosa: Treatment with intravenous immune globulin

Intravenous immune globulin was used to treat Pseudomonas aeruginosa infected, burned mice. Protection was dose-related and large amounts of intravenous immune globulin administered early in the infection process were necessary for full protection. Intravenous immune globulin is processed differently in unburned, burned, and burned, infected mice with significantly lower plasma levels in the burned, infected animals 36 hours after a standard dose is given. At 30 hours post-treatment, bacterial counts in the skin and liver tissue of untreated, burned, infected mice are significantly higher than in mice given a protective dose of intravenous immune globulin. Adsorbtion of intravenous immune globulin with heat-killed cells reduces its protective effects; adsorbtion with formalin-killed cells reduces its protective effects even more.