IVIG Dosing for Therapeutic Plasma Exchange
The standard IVIG dose following therapeutic plasma exchange is 400 mg/kg (0.4 g/kg), though higher doses of 1-2 g/kg may be used depending on the underlying condition being treated. 1
Context-Specific Dosing
The appropriate IVIG dose after TPE depends critically on the indication:
For Prevention of Hypogammaglobulinemia Post-TPE
- Standard replacement dose: 400 mg/kg administered after plasma exchange procedures to prevent secondary hypogammaglobulinemia 2, 3
- This dose can be repeated every 2-4 weeks if ongoing TPE is required 2
For Autoimmune Conditions Requiring TPE + IVIG
- 1-2 g/kg total dose (typically divided over 2 consecutive days) is recommended when IVIG serves as both replacement and immunomodulatory therapy 1
- For pemphigus vulgaris treated with TPE: 1.2-2 g/kg divided over 3-5 days, repeated every 2-4 weeks 4
- For D alloimmunization: Loading dose of 2 g/kg over 2 days after initial TPE series, followed by 1 g/kg weekly maintenance 5
For Thrombotic Thrombocytopenic Purpura (TTP)
- When IVIG is used as adjunct to TPE for chronic relapsing TTP: 1 g/kg as single dose, which may be repeated if necessary 6, 7
- The 1 g/kg regimen produces faster platelet response than lower dose regimens 6, 8
Critical Timing Considerations
IVIG should be administered after plasma exchange is completed, not before, to avoid removing the infused immunoglobulin 5. The exception is when IVIG is given concurrently with continuous TPE in life-threatening hemorrhage scenarios 6.
Important Caveats
- Screen for IgA deficiency before first IVIG administration to prevent severe anaphylaxis; use IgA-depleted preparations if deficiency is detected 1
- Monitor renal function during and after IVIG administration, as renal failure is a serious potential complication 1, 6
- Consider premedication with diphenhydramine and acetaminophen to reduce infusion reactions 1
- For patients with cardiac dysfunction or fluid overload risk, divide the dose over 2 days (e.g., 1 g/kg daily × 2) rather than single infusion 1
Dosing by Body Weight
Use ideal body weight (IBW) or adjusted body weight for obese patients (BMI ≥30), not actual body weight, to avoid excessive dosing 1.