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Intravenous Immunoglobulin – How to use it

Department of Neuroimmunology, Guy’s, King’s and St Thomas’ School of Medicine, Guy’s Hospital, London SE1 1UL. Email: Jane.pritchard{at}kcl.ac.uk

EXTRACT

WHAT IS IT?

The immunoglobulin used in intravenous immunoglobulin (IVIg) is prepared from the pooled plasma from about 8000 blood donors. Plasma purification includes steps to remove viruses. Donors at risk for transfusion-related viruses are excluded and IVIg consists almost entirely of IgG with traces of IgM, IgA and soluble plasma factors including cytokines. Its initial use was as replacement therapy in hypogamma-globulinaemia. Its success in treating autoimmune thrombocytopenic purpura led to its use in other immune-mediated diseases.

HOW DOES IT WORK?

We do not really know. There are many proposed mechanisms. Different, possibly multiple, mechanisms may apply in different diseases (Fig. 1).

WHO NEEDS IT?

Guillain–Barré Syndrome (GBS) and Kawasaki disease are the only neurological conditions licensed for IVIg treatment in the United Kingdom. The strength of the evidence for the use of IVIg in other neurological conditions varies. Consensus does not exist. Tables 1, 2 and 3 ...

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