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CBS Clinical Guide, Even Numbered Chapters > Chapter 4: Immuneglobulin Products > Flashcards

Chapter 4: Immuneglobulin Products Flashcards

(52 cards)

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1
Q

List 3 types of immune globulin products provided by CBS.

A

IVIg
SCIg
RhIg

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2
Q

How do immuneglobulin products affect vaccine efficacy?

A

IVIig leads to decreased response to parenteral live virus vaccines
BUT NOT inactivated virus vaccines Live oral/intranasal vaccines, or BCG

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3
Q

What formats do immuneglobulin products come in?

A

sterile solutions
lyophilized concentrates

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4
Q

What class of human immunoglobulin are immuneglobulin products made from?

A

IgG

May have traces of others

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5
Q

How can Immunoglobulin administration affect serological testing results?

A

passively transferred antibodies in the patient’s blood may cause positive serological testing results, which can be misinterpreted

E.g.:

Passive transmission of antibodies to red cell antigens (e.g., A, B, and D) may cause a positive direct or indirect antiglobulin (Coombs) test.

serological testing results for other antibody-mediated tests (e.g., hepatitis B core antibody [anti-HBc], hepatitis A, varicella) may also be misleading

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6
Q

Why should we do hepatitis B testing with hepatitis B surface antigen (HBsAg) in patients before Ig therapy is initiated?

A

After Ig administration, serological testing results for hepatitis B core antibody [anti-HBc], hepatitis A, may be misleading.

We should test before giving Ig to inform the risk of hepatitis B reactivation

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7
Q

What resource can you consult of you want to know what Ig products are offered by CBS?

A

E-formulary for plasma protein and related products

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8
Q

What is the method of action by which IVIg offers protection against infection and supplementation for congenital/primary and acquired/secondary immune deficiency

A

By supplementing array of IgG antibodies to facilitate destruction and neutralization of pathogens

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9
Q

What is the proposed mechanism by which IVIg helps with immune modulation in autoimmune or modulatory conditions

A

anti-inflammatory activity by dendritic cells and/or blockade of Fc receptors in the reticuloendothelial system

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10
Q

What is the proposed mechanism by which IVIg helps with immune modulation in autoimmune or modulatory conditions

A

anti-inflammatory activity by dendritic cells and/or blockade of Fc receptors in the reticuloendothelial system

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11
Q

What is the proposed mechanism by which RhIg prevents alloimmunization against RhD?

A

Accelerated clearance of RhIg coated cells

Suppression of B-cell mediated response to Rh exposure and mitigation of Rh alloimmunization

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12
Q

List 6 indications for IVIg

A

Primary immune deficiency (PID)
Secondary immune deficiency (SID)
ITP
Chronic inflammatory demyelinating polyneuropathy (CIDP)
Guillain-Barré syndrome (GBS)
Multifocal motor neuropathy (MMN)

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13
Q

Why are there authorization forms for IVIg ordering and who provides regional guidance on the use of IVIg in Canada?

A

BC blood coordinating office
ORBCoN
Atlantic blood utilization strategy working group

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14
Q

What group developedcriteria for the clinical use of Igas part of an evidence-based framework to aid transfusion services and clinicians?

A

Prairie Collaborative Immune Globulin Utilization Management Framework Project

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15
Q

Who provides guidance on utilization of there are Ig shortages in Canada?

A

National Advisory Committee on Blood and Blood Products (NAC)

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16
Q

IVIg is contraindicated for what groups of individuals?

A

People with:
IgA deficiency and anti-IgA antibodies
Prior anaphylaxis or multiple severe allergic reactions

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17
Q

What Ig products can you use for individuals with IgA deficiency who have anti-IgA antibodies instead of IVIg?

A

SCIg

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18
Q

Do we routinely test for IgA deficiency before IVIg?

A

No

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19
Q

IVIG dosing?

A

Depends on clinical indication

Immune replacement 0.4–0.6 g/kg a month + extra dose in the first month of therapy if serum IgG low

Immunosuppressive dose: 1–2 g/kg over 1–5 days, and some conditions may require ongoing maintenance therapy, usually given monthly, with efforts made to reduce the dose or extend the treatment interva

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20
Q

IVIG dosing?

A

Depends on clinical indication

Immune replacement 0.4–0.6 g/kg a month + extra dose in the first month of therapy if serum IgG low

Immunosuppressive dose: 1–2 g/kg over 1–5 days, +/- monthly maintenance

Reduce the dose or extend the treatment interval as tolerated

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21
Q

IVIg hemolysis mechanism?*

22
Q

Contraindications to IVIg?

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A

IgA deficiency with anti-IgA antibodies. Can try SCIg with such patients instead.

23
Q

Alternative for patients who have had anaphylaxis or multiple severe reactions to IVIg?

24
Q

Privigen contraindications?

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A

Same as IVIg plus hyperprolinemia

25
Weight adjusted dosing for immune globulin products- what is the formula?
Dosing weight = ideal weight + [0.4x (actual weight - ideal weight)] If patient weight is less than IBW, or patient is a child, use actual weight
26
Weight adjusted dosing for immune globulin products- what is the formula?
Dosing weight = ideal weight + [0.4x (actual weight - ideal weight)] If patient weight is less than IBW, or patient is a child, use actual weight
27
How is ideal body weight calculated?
Male @ birth: 50 kg + 2.3 kg/ inch over 5 ft Female @ birth: 45.5 kg x 2.3 kg,/inch over 5 ft
28
IVIg infusion rate?
0.01 mL/kg/min Increase or decrease based on patient tolerance
29
IVIg storage temperature?
2-25 degrees C
30
IVIg adverse events? How to manage,?
Minor: H/a Fever, chills Anxiety Nausea Pruritis/rash Chest pain Slow infusion rate, stop infusion, premedicate, switch product Severe: Hemolysis Aseptic meningitis Anaphylaxis TRALI Thromboembolism
31
Is IVIg hemolysis usually DAT pos or neg?
DAT Positive
32
Define IVIg associated hemolysis
Drop of Hgb by 10 or more Positive DAT Within 10 days of IVIg AND (need at least 2): Increased retics Increased LDH Low hapto Increased unconjugated bili Red serum hemoglobinemia Hemoglobinuria Spherocytosis
33
Define IVIg associated hemolysis
Drop of Hgb by 10 or more Positive DAT Within 10 days of IVIg AND (need at least 2): Increased retics Increased LDH Low hapto Increased unconjugated bili Red serum hemoglobinemia Hemoglobinuria Spherocytosis
34
What increases risk of IVIg hemolysis?
High dose especially at 2g/kg Non O blood group due to passive transfer of anti-A and anti-B isohemagglutins and density of A and B Ag on RBC surface Highway Rush: group A pr SB patient getting 2g/kg or higher
35
Cause of aseptic meningitis from IVIg? How to recognize aseptic meningitis?
Dose related Typically occurs within 6-48 hours CSF shows high protein, normal to low glucose, WBC pleocytosis, neg cultures Recovery within 5 days Possible future recurrence with IVIg
36
Anaphylaxis in IVIg
IgA deficiency with anti IgA antibodies Significance of Ab Class (IgG vs IgE anti-IgA) Can try SCIg or IgA depleted products
37
Anaphylaxis in IVIg
IgA deficiency with anti IgA antibodies Significance of Ab Class (IgG vs IgE anti-IgA) Can try SCIg or IgA depleted products
38
What Thromboembolic events can occur with IVIg?
CVA TIA DVT PE Retinal vein occlusion Retinal artery infarct
39
Timeframe of IVIg related thromboembolism in relation to IVIg infusion?
During or up to 8 days after
40
Timeframe of IVIg related thromboembolism in relation to IVIg infusion?
During or up to 8 days after
41
Patients at increased risk of IVIg related thromboembolism?
CV disease Immobilization Advanced age H/o Thromboembolic events Mitigate risk by hydration, monitoring, slow infusion, lower doses
42
SCIg indications?
Replacement therapy in PID or SID (lifelong) Immunomodulation in CIDP
43
Benefits of SCIg over IVIg?
Convenience/lifestyle No vascular access needed Less truth of side effects
44
SCIg contraindications?
History of anaphylactic or severe allergic reactions to Ig products (but this is also a reason who patients switch from IVIg to SCIg ... Confusing)
45
Storage temperature of SCIg?
2-25C
46
Dose and administration of SCIg?
Depends on brand 100-200 mg/kg,/wk plus extra 0.4 g/kg n first month if very low serum IgG Administration rate varies
47
Dose and administration of SCIg?
Depends on brand 100-200 mg/kg,/wk plus extra 0.4 g/kg n first month if very low serum IgG Administration rate varies
48
Calculation for switching from IVIg to SCIg?
Divide monthly IVIg dose by 4 to get weekly SCIg dose then titrate to get trough levels at bottom of serim IgG ref range for age Average dude 100-125 mg/kg/wk Can give cumulatively q 3-4 weeks thereafter
49
Adverse reactions with SCIg?
Similar to IVIg
50
What are hyperimmune globulin fractionation products?
Mar from pooled plasma Select for high Ab titres with desired specificities Viral inactivation
51
hyperimmune globulin products?
RhIg Hep B Ig VZV Ig CMV Ig Intramuscular Ig
52
Storage temperature for hyperimmune globulin products?
2-8C User within 4 hours of reconstitution

CBS Clinical Guide, Even Numbered Chapters (4 decks)

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