Intravenous immunoglobulin (IVIG) is a blood product used in the treatment of inflammatory or autoimmune diseases, hypogammaglobulinemia and other diseases featuring low antibody levels.

It contains the pooled immunoglobulins (antibodies) extracted from the plasma of over a thousand blood donors. It is administered intravenously; in autoimmune diseases its effects last between 2 weeks and 3 months.

Mechanism of action

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The precise mechanism by which IVIG suppresses harmful inflammation is unknown. The donor antibody may bind directly with the abnormal host antibody, stimulating its removal. Alternatively, the massive quantity of antibody may stimulate the host's complement system, leading to enhanced removal of all antibodies, including the harmful ones. IVIG also blocks the antibody receptors on immune cells (macrophages), leading to decreased damage by these cells.

Uses of IVIG

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Diseases in which IVIG is used include:

• multiple sclerosis
• myasthenia gravis
• acute inflammatory polyradiculoneuropathy (AIDP, Guillain-Barré syndrome)
• chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)
• multifocal motor neuropathy with conduction block (MMN)
• immune thrombocytopenic purpura (ITP)
• rheumatoid arthritis
• systemic lupus erythematosus (SLE)
• dermatomyositis and polymyositis
• aplastic anaemia
• asthma (rarely)
• common variable immunodeficiency (CVID)
• respiratory syncytial virus (RSV) infection
• kawasaki disease Kawasaki disease

In chronic lymphocytic leukemia and multiple myeloma, as well as various rare deficiencies of immunoglobulin synthesis (e.g. hypogammaglobulinemia), IVIG is administered to maintain adequate immunoglobulin levels to prevent infections.

Complications and side effects

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Complications of IVIG therapy include

• headache
• dermatitis - usually peeling of the skin of the palms and soles
• infection (such as HIV or viral hepatitis) by contaminated blood product; there is also an as yet unknown risk of contracting variant CJD (vCJD).
• pulmonary oedema from fluid overload, due to the high colloid oncotic pressure of IVIG
• allergic/anaphylactic reactions
• damage such as hepatitis caused directly by antibodies contained in the pooled IVIG
• acute renal failure
• venous thrombosis
• aseptic meningitis

References

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• Emedicine page

Medical treatments