What is the proper administration protocol for Intravenous Immunoglobulin (IVIG)?

Intravenous Immunoglobulin (IVIG) Administration Protocol

IVIG should be administered at a dosage of 1-2 g/kg of ideal body weight, usually given over 2 consecutive days (1 g/kg each day), and may be repeated monthly for 1-6 months depending on the clinical indication. 1

Pre-administration Assessment

• Check serum IgA levels before administering IVIG, as IgA deficiency may lead to fever, infusion reactions, or severe anaphylaxis 1
• If IgA deficiency is detected, use an IVIG preparation with reduced IgA levels 1
• Review patient's medical history for risk factors:
  • Renal insufficiency (requires products without sucrose)
  • History of thrombosis
  • Cardiovascular disease
  • Diabetes (monitor blood glucose during infusion)

Dosing Guidelines by Indication

Immune Thrombocytopenia (ITP)

• Initial dose: 1 g/kg as a one-time dose 1
• May be repeated if necessary 1
• Use in conjunction with corticosteroids when rapid increase in platelet count is required 1

Inflammatory Myopathies (Dermatomyositis/Polymyositis)

• Dosage: 1-2 g/kg of ideal body weight 1
• Administration: Usually over 2 consecutive days (1 g/kg each day) 1
• Frequency: Monthly for 1-6 months 1

Kawasaki Disease

• Standard dosage: 2 g/kg as a single infusion 1

Administration Protocol

1. Preparation:

   • Calculate dose based on ideal body weight rather than actual body weight for obese patients 2
   • If dose exceeds 80 g, consider administering over 3-5 days at 0.4 g/kg/day 1

2. Initial Infusion Rate:

   • Start at 0.5 mg/kg/min 3
   • Gradually increase to 4-8 mg/kg/min as tolerated 3
   • Ensure adequate hydration before infusion 3

3. Monitoring During Infusion:

   • Monitor vital signs every 15-30 minutes 3
   • Watch for signs of adverse reactions:
     • Headache, flushing, fever
     • Hypertension or hypotension
     • Anaphylactic reactions

4. Management of Adverse Reactions:

   • Mild reactions: Reduce infusion rate, administer antihistamines 3
   • Moderate to severe reactions: Temporarily stop infusion, administer corticosteroids, restart at slower rate if symptoms resolve 3
   • Anaphylactic reactions: Stop infusion immediately, administer epinephrine, antihistamines, corticosteroids, and provide vital support 3

Special Considerations

• For patients requiring plasmapheresis, schedule IVIG administration after completion of plasmapheresis sessions to prevent removal of IVIG 3
• If using rituximab with IVIG, hold plasmapheresis for 48-72 hours after rituximab infusion 3
• Combined therapy with plasmapheresis and immunosuppression increases infection risk 3

Common Pitfalls to Avoid

1. Incorrect weight-based dosing: Using actual body weight instead of ideal body weight in obese patients can lead to overdosing and increased adverse effects 2

2. Failure to check IgA levels: Not checking IgA levels before administration can lead to severe anaphylactic reactions in IgA-deficient patients 1

3. Infusion rate too rapid: Administering IVIG too quickly is associated with increased adverse reactions 3

4. Inadequate monitoring: Failing to monitor vital signs during infusion may result in missed early signs of adverse reactions

5. Poor timing with other therapies: Administering IVIG before plasmapheresis will result in removal of the therapeutic agent and reduced efficacy 3

By following this protocol, you can optimize the safety and efficacy of IVIG administration while minimizing the risk of adverse events.