Little Leakers
IVIG Infusions
Immune globulin (Ig) is a sterilized solution obtained from pooled human blood plasma, which contains the
immunoglobulins (or antibodies) to protect against the infectious agents that cause various diseases. Antibodies are
substances in the blood plasma that fight infections. Our bodies create antibodies (or immunity) against
disease-causing agents when infections occur. These antibodies can protect us from becoming ill if we are exposed to
the same infectious agents sometime in the future. When someone is given IG, that person is using other people's
antibodies to help fight off or prevent an illness from occurring. This protection is temporary and should not be
confused with getting an immunization, which provides longer-term protection. Special Ig formulations are produced
from donors with high levels of antibodies against hepatitis B (Hepatitis B Immune Globulin-HBIG), rabies (Rabies
Immune Globulin-RIG), tetanus (Tetanus Immune Globulin-TIG) and varicella (chickenpox) (Varicella Zoster Immune
Globulin-VZIG). Immune globulins are sometimes called gamma globulins or immune serum globulins.
Since Immune globulin is made from blood plasma, can I get AIDS or other diseases from it?
Prior to use, each unit of Ig is tested for evidence of the virus that causes acquired immune deficiency syndrome (AIDS),
hepatitis B & C, and many other blood-borne viruses and bacteria. Units that carry these viruses and/or bacteria are
eliminated. In addition, several chemical processes are used to sterilize the product to eliminate other disease-causing
germs. There is no evidence that Ig causes disease, despite several studies that have looked into this. No cases of
AIDS have been due to the receipt of Ig. Immune globulin administered in the United States is a very safe and effective
preventive against disease.

Who should receive Immune globulin?
People exposed to or in danger of being exposed to certain infectious diseases (i.e., hepatitis, measles, rabies, tetanus
and varicella) may be offered injections with the appropriate Ig. Ig recipients should realize that, although the product
is highly effective, it is not 100% effective in preventing disease. Some individuals may develop the infection they were
exposed to in spite of having received Ig. That is why additional precautions may need to be taken to further protect
the person or others from disease. For example, if you were exposed to hepatitis B, you would want to avoid donating
blood for six months after receiving Ig in case the Ig wasn't effective in preventing the disease from occurring.

Who should not receive Immune globulin?
Ig should not be given to individuals who are known to have had serious allergic reactions to thimerosal (for example,
a generalized body rash, difficulty breathing, and swollen lips), or other immune globulins. Individuals with blood
clotting disorders that would prevent them from safely obtaining an injection and those with IgA deficiency (a rare
blood disorder) should not receive Ig.  Shock-like reactions to intramuscularly administered Ig are rare. Recipients are
encouraged to wait 20 minutes in the clinic after the injection.
Because Ig may interfere with development of good protection after measles, mumps, rubella or varicella vaccination,
people who have received Ig should not receive these vaccines for the next three months. If Ig is given during the
two-week period following an immunization against measles, mumps, rubella or varicella, the immunization should be
repeated three months after the Ig was received.

How is Immune globulin administered?
Ig is given by injection into a muscle. The dosage and the site for the injection vary according to the amount of Ig
required and the size of the person (typically this is in the buttocks for adults, and the leg or arm for children.)
What are the side effects of Immune globulin?
Local pain, tenderness, itching, and swelling at the injection site is to be expected and typically goes away within a
day. Non-prescription medications such as aspirin or acetaminophen can be used to lessen any discomfort.
If your blood is tested after receiving Ig, it may show evidence of the antibodies to various diseases during the three
months after injection. Be sure to let any health care provider you see in the next three months know you have
received Ig.

How long can I expect the protection from Immune globulin to last?
Ig administered by injection persists in the body for several months. The protective effect of the injection disappears
after approximately three months. If risk of exposure to disease continues individuals may require additional Ig.

What are the  differences in brands of IVIG?
Generally the difference between brands of  IVIg is in the amount of IgA content and also if the IVIg contains sucrose,
glucose or some other sugar. Some IVIg products have Glycine while another one has no preservatives.

Different IVIg products match different patients. In general all the products work about the same. Some IVIg products
have a 5% concentration others can be made 10%. The concentration of IVIg will make if thinner or thicker.

IVIG and vaccination issue.

IVIG prevents vaccinations to take any effect in your body.

Immunizations should not be given for at least 1 month -- and preferably 3 months -- after a course of IVIG.

If on IVIg you may not need routine flu shots. As you are getting  the antibodies. (Check with your physician).

Why is IVIG so expensive?  

IVIg is obtained from plasma donors who are paid then the plasma is sent to  a processing centers for mixing, antibody
removal, chemical treatment and filtration to remove viruses. This  is followed by the  products to be freeze dried. All
this ends up for IVIG to be priced at $ 48 to $ 60 a gram (cost price of IVIg). A single infusion of IVIg may cost about
$3000 for a child to $10,000 for adults. For a child the cost is lower as a small IVIg dose is used.

The cost of IVIg in India is $25 a gram and in Pakistan $20 a gram, lower prices are found in China where the
manufacturer will see IVIg for $10-5 a gram.

What Are the Risks Involved in the Use of IVIG?

The incidence of adverse events associated with the administration of IVIG is reported by the manufacturers to be in
the range of 1 to 15 percent, usually less than 5 percent. Most of these reactions are mild and self-limited. Severe
reactions occur very infrequently and usually do not contraindicate further IVIG therapy. Neither HIV nor hepatitis B
infection has been transmitted to recipients of products currently licensed in the U.S. The various IVIGs are
manufactured from large numbers of donors whose plasma has been tested and found to be negative for hepatitis B
surface antigen and HIV antibody. A number of adverse events have been recognized. These include the following:

pyrogenic reactions marked by high fever and systemic symptoms;
minor systemic reactions with headache, myalgia, fever, chills, lightheadedness, nausea and/or vomiting;
vasomotor and/or cardiovascular manifestations, marked by changes in blood pressure and tachycardia. These may be
related to occasional reports of shortness of breath and chest tightness; and
hypersensitivity and anaphylactic reactions.


Risk factors

Patients with primary antibody deficiency syndromes may be at increased risk for reactions. Anaphylactic reactions
induced by anti-IgA can occur in individuals who have a total absence of circulating IgA and antibodies to IgA. These
are extremely rare in panhypogammaglobulinemic individuals and potentially more frequent in patients with subclass
deficiencies. Frequency of reactions may be correlated with volume and/or rate of infusion. Seriously ill patients with
compromised cardiac function may be at increased risk of vasomotor or cardiac complications manifested by elevated
blood pressure and/or cardiac failure.

Prevention and Management

Adverse reactions often can be alleviated by reducing the rate or the volume of infusion. For patients with repeated
severe reactions unresponsive to these measures, hydrocortisone, 1-2 mg/kg, intravenously, can be given 30 minutes
before IVIG infusion. In those rare instances when reactions related to anti-IgA antibodies have occurred, use of
IgA-depleted preparations will reduce the likelihood of further reactions. Avoidance of anaphylactic reactions may
require the use of material completely devoid of IgA. Because the combination of the absence of IgA and the presence
of anti-IgA antibodies is infrequent and reactions are rare, screening for IgA-deficiency is not routinely recommended
for potential recipients of IVIG.

As with any biologic or pharmacological product, the potential for new or previously unrecognized adverse events
should be anticipated. With IVIG these include the following:

transmission of blood-borne pathogens, such as the newly identified hepatitis C virus.
Immunosuppression--for example, administration of IVIG has been associated with transient effects on immune
response that do not appear to have clinical significance. However, with increased dosage of IVIG or new products for
the treatment of specific infections, the possibility of adverse outcomes from immunosuppression should be considered.


After nearly a decade of experience, the safety of IVIG has been established. For any potential recipient, the small risk
of adverse reactions must be weighed against the likelihood of significant benefit. For those patients who require
repeated courses of IVIG such as those with a primary humoral immunodeficiency home infusion by the patient or a
family member after adequate training has been effectively utilized and is cost-effective.


resource: metrokc.gov/health/prevcont/ig.htm, cidpusa.org/ivig.html, Some Data provided from the National Library of
Medicine