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

IVIG Administration Protocol

IVIG should be administered at 1-2 g/kg of ideal body weight, usually given over 2 consecutive days, with dosing adjusted based on specific indications, and should be preceded by assessment for IgA deficiency to prevent severe reactions. 1

Pre-Administration Assessment

• Check serum IgA levels before administering IVIG to prevent fever, infusion reactions, or severe anaphylaxis in patients with IgA deficiency 1
• If IgA deficiency is detected, use an IVIG preparation with reduced IgA levels 1
• Review patient's medical history for risk factors such as renal dysfunction, thrombotic risk, or history of previous infusion reactions 1
• Evaluate cardiac function before administration, particularly in patients with cardiac dysfunction 1

Premedication

• Administer diphenhydramine and acetaminophen as premedication before IVIG infusion 1
• Consider corticosteroids for patients with a history of infusion reactions 1

Dosing Guidelines by Indication

• Immunodeficiency disorders: 300-400 mg/kg IV monthly for replacement therapy 1
• Idiopathic Inflammatory Myopathies: 1-2 g/kg of ideal body weight over 2 consecutive days 1
• Immune Thrombocytopenic Purpura: 1 g/kg as a one-time dose, which may be repeated if necessary 1
• Kawasaki Disease: 2 g/kg IV as a single infusion 1
• Guillain-Barré Syndrome: 0.4 g/kg/day for 5 days (total dose of 2 g/kg) 1
• Multisystem Inflammatory Syndrome in Children (MIS-C): 2 g/kg based on ideal body weight 1
• Cardiac transplantation (antibody-mediated rejection): 500 mg/kg IV once daily for 4 days or 2 g/kg divided into 2 doses over 2 consecutive days 1

Administration Technique

• Ensure proper hydration of the patient before and during infusion to prevent renal failure 2
• Start with a slow infusion rate and gradually increase if tolerated 2
• For patients with cardiac dysfunction, use divided dosing (1 g/kg daily over 2 days) to minimize fluid overload 1
• Standard initial infusion rate is 0.08 mL/kg/min, which can be increased to 0.14 mL/kg/min if tolerated in most patients 3

Monitoring During Administration

• Monitor vital signs (blood pressure, heart rate, temperature) throughout the infusion 1
• Monitor renal function, including urine output and serum creatinine 1
• Be vigilant for signs of adverse reactions, particularly in the first 30-60 minutes of infusion 2

Management of Adverse Reactions

• Most adverse effects are mild and transient, including headaches, flushing, fever, chills, fatigue, nausea, diarrhea, blood pressure changes, and tachycardia 2
• For severe reactions such as anaphylaxis or severe hypotension, immediately stop the infusion, administer epinephrine, and notify a physician 1
• Serious adverse events are rare but include acute renal failure and thromboembolic events, particularly in insufficiently hydrated patients or those with risk factors 2

Special Considerations

• Patients with risk factors for thromboembolic events (advanced age, previous thromboembolic events, immobilization, diabetes mellitus, hypertension, dyslipidemia) require slower infusion rates 2
• IVIG is contraindicated in patients with selective IgA deficiency and detectable IgA antibodies 4
• Children younger than 5 years of age typically experience fewer adverse events than older patients 5

Post-Administration Monitoring

• Assess clinical response to IVIG therapy based on indication-specific parameters 1
• Monitor for delayed adverse reactions, particularly renal dysfunction and thromboembolic events 2