By Michelle Greer, RN, MBA
Many people begin intravenous immune globulin (IVIG) therapy with little to no understanding of what it is and what it does. Immune globulins are antibodies that are part of the immune system. Antibodies are produced and mature in bone marrow and are an important part of a healthy immune response. IVIG is given when there is a deficiency or malfunction in antibody production. When there are not enough antibodies produced, or if those that are produced do not function properly, it can result in an immune deficiency. IVIG replaces this deficiency. When the immune system malfunctions and creates antibodies that attack one’s own body (autoantibodies), this can result in an autoimmune disease. IVIG is used to suppress the immune system so this attack subsides and symptoms resolve.
IVIG is made from thousands of pooled human plasma donations. To prevent transmission of blood-borne viruses or diseases, plasma donors are carefully screened, and the donated plasma is tested and treated to ensure it does not contain any pathogens. Basically, each person and their donated blood are tested prior to combining it with other donors, known as pooling. IVIG manufacturing has evolved over the years, and the product is very safe.
There are several manufacturers of IVIG, and each one uses a slightly different process to separate the antibodies from the plasma. These differences may result in patients having better tolerability with one brand over another. Antibodies cause reactions in the body. For instance, infusing them quickly from start to finish can cause severe and intolerable side effects. This is why an infusion is started very slowly and gradually increased to a predetermined maximum rate to decrease the potential side effects. In addition, if side effects are experienced, sometimes simply pausing the infusion and restarting at a slower rate is enough to alleviate them. Each person tolerates IVIG differently; therefore infusion times vary from person to person and should be determined by the doctor and/or pharmacist.
Once the infusion time is determined, the next step is to find out how the patient is tolerating it. If there are side effects, the infusion can be slowed. If there are no side effects, the IVIG may be able to be infused more quickly. IVIG can be a very lengthy infusion, so if it can be safely infused more quickly, it can shorten the process. Any changes from the original infusion time that was approved by the physician should be approved again. And, it is important for a patient to know his or her brand, how many grams he or she is receiving and what the infusion schedule is, including rates and duration. Do you?