Nonspecific Immunoglobulins

Immunoglobulins (Ig) are obtained by fractionation and subsequent viral inactivation of pooled plasma from thousands of blood donors. These blood products contain predominately human IgG, as well as variable amounts of human IgM and IgA. Nonspecific Ig can be administered as subcutaneous infusion (SCIG) or as intravenous infusion (IVIG); IM injections are rarely used. The method of storage and shelf life are specified by the manufacturer and may vary between products.

IndicationsTop

1. Substitution in immunodeficiency states: Inborn errors of immunity affecting antibody production or function, chronic lymphocytic leukemia (CLL), multiple myeloma, reduced immune function following hematopoietic stem cell transplant.

2. Immunomodulatory effect (nonexhaustive list):

1) Neuroimmunologic disorders: Chronic inflammatory demyelinating polyneuropathy (CIDP), multifocal motor neuropathy, Guillain-Barré syndrome (GBS), myasthenia gravis (MG).

2) Autoimmune/inflammatory conditions: Immune thrombocytopenia (ITP), autoimmune hemolytic anemia (AIHA), autoimmune neutropenia, acquired von Willebrand syndrome, Kawasaki disease, multisystem inflammatory disease in children (MIS-C) associated with coronavirus disease 2019 (COVID-19).

3) Infections and infection-related disorders: Chronic parvovirus infection complicated by anemia, toxic shock syndrome, measles postexposure prophylaxis (if the patient is immunocompromised or nonimmune).

4) Alloimmune processes: Hemolytic disease of the fetus and newborn (HDFN), posttransfusion purpura, antibody-mediated organ transplant rejection, hemolytic crisis in patients with sickle cell disease who have received transfusions.