From the Guidelines
Yes, Intravenous Immunoglobulin (IVIG) elevates Erythrocyte Sedimentation Rate (ESR) 1.
Key Points
- The ESR is often used as a marker of inflammation, and IVIG can affect this measurement 1.
- In the context of Kawasaki disease, IVIG is used to reduce the prevalence of coronary artery abnormalities, and its effect on ESR is a consideration in monitoring disease activity 1.
- The mechanism of action of IVIG in treating Kawasaki disease is unknown, but it appears to have a generalized anti-inflammatory effect 1.
- The standard dose of IVIG for Kawasaki disease is 2 g/kg as a single infusion, usually given over 10 to 12 hours 1.
- It is important to note that IVIG can have varying effects on different patients, and its impact on ESR should be considered in the context of individual patient care 1.
Clinical Implications
- When using IVIG to treat conditions like Kawasaki disease, clinicians should be aware of its potential to elevate ESR and consider alternative markers of inflammation, such as C-reactive protein (CRP), for monitoring disease activity 1.
From the Research
Effect of IVIG on ESR
- The administration of Intravenous Immunoglobulin (IVIG) has been observed to affect the Erythrocyte Sedimentation Rate (ESR) in various studies 2, 3, 4, 5.
- A study published in the Journal of tropical pediatrics in 2005 found that high-dose IVIG increased ESR significantly 24 hours after administration, and this elevated level was sustained for 7 days 2.
- Another study published in the International journal of pediatrics in 2014 reported that IVIG caused a significant increase in ESR in children, with a mean ESR of 31.8 ± 29.04 before IVIG and 47.2 ± 36.9 after IVIG 4.
- The European journal of pediatrics published a study in 2018 that found ESR to be higher in the IVIG-resistant group compared to the IVIG-sensitive group 3.
- A study published in the Singapore medical journal in 2006 also found that patients who did not respond to IVIG had higher ESR than those who responded to initial treatment 5.
Clinical Implications
- The increase in ESR after IVIG administration may be a non-inflammatory response, making it unreliable for monitoring treatment response 4.
- High ESR has been associated with an increased risk of IVIG-resistant Kawasaki disease 3, 5.
- The use of ESR as a laboratory indicator should be interpreted cautiously in patients who have received IVIG 4.