Indications for IVIG

Here, we will discuss 6 possible indications for immunoglobulin (IVIG) therapy:

This is a controversial issue. Evidence that exists is based upon case series and personal experience. There is some suggestion that the recommendation for IVIG has been extrapolated from the literature regarding the management of necrotizing fasciitis. In my experience, IVIGs do have a role, above and beyond the theoretical risk of infection from human products. The Department of Health’s interim guidelines¹ suggest that immunoglobulins should be given. A good example of this can be found in this case report².

Guillane-Barré syndrome/Bickerstaff's brain stem encephalitis

The role of IVIGs in GBS & BBE is unclear. The general feeling is that it should be given in exceptional circumstances, but if the patient is requiring invasive ventilator support, then it may be give. A good example of this can be found in this case report³.

Necrotizing Fasciitis (type 2)

Two types of necrotizing fasciitis are recognized. Type 1 involves at least one anaerobic species in combination with one or more facultative anaerobic species. Type 2 is caused by Group A β-haemolytic streptococci either alone or in combination with other species. For type 2 disease, there is a role for IVIG as an adjunct to broad antibiotic therapy and debridement.

Immune Thrombocytopaenic Purpura

The precise action of IVIG in ITP is unknown, but it's thought to block platelet removal and so increase their number. IVIG treatment provides only a temporary response, so it is mainly of benefit in acute ITP.
In chronic ITP it may be used when a temporary rise in platelets is desired or during pregnancy because the risk to the baby is less than with other treatments.

Kawasaki’s Disease

Kawasaki disease is a disease that primarily affects children under five years old. The cause of Kawasaki disease is not known. Its symptoms are persistent fever, red eyes and lips, strawberry tongue, rash and swollen lymph nodes. If not detected and treated immediately, Kawasaki disease can result in heart damage and occasionally death. Intravenous immunoglobulin involves injecting antibodies purified from donated blood. The review of trials found that intravenous immunoglobulin given within the first 10 days of the disease reduces the risk of damage to the coronary arteries of the heart in children, without serious adverse effects.

The Cochrane review can be found here⁴.

Haemophagocytosis

This is a syndrome characterized by marked proliferation of phagocytic histiocytes in hematopoietic organs including bone marrow and association with underlying viral / bacterial infections or NK/T cell lymphomas. Here, IVIG can be used as a method of immunomodulation. This is a good referenence⁵.

References:

1. DoH PVL Working Party.

2. http://jmm.sgmjournals.org/cgi/content/abstract/56/10/1407

3. http://jcp.bmj.com/cgi/content/extract/60/10/1161

4. http://www.cochrane.org/reviews/en/ab004000.html

5. http://www.nature.com/bmt/journal/v37/n8/abs/1705329a.html

AMH.