Page 69 - Heart Transplant Protocol

Heart Function Service: Heart Transplant Protocols

Protocol for Administration of Intravenous Immunoglobulin (IVIG)

Purpose: To provide procedures for administrating and for monitoring patients receiving Intravenous
Immunoglobulin (IVIG)

Policy:

SM
A. Those who administer IVIG and monitor patients receiving IVIG at Children’s Health will follow
the established Protocols included in this document
B. The procedure will be revised and approved by the Pharmacy & Therapeutics Committee at
Children’s Health as needed according to notifications recommended by the
manufacturer/evidence in the clinical literature.
C. IVIG therapy may provide benefit for a variety of disease states. The dose can vary from 0.1-2
gram/kg per dose depending on indication. (See Attachment A “IVIG Indications and Suggested
Dosing”) Some disease states may benefit from repeat doses and individualization of dose and
regimen. During times of limited IVIG supply, use is to be reserved for those indications with
Food and Drug Administration (FDA) approval and off-label indications that have demonstrated
benefit, provided the risks of administration have been carefully considered.

BLACK BOX WARNING: IVIG products have been reported to be associated with renal dysfunction,
acute renal failure, osmotic nephrosis, and death. Patients predisposed to acute renal failure include
patients with any degree of pre-existing renal insufficiency, diabetes mellitus, age greater than 65,
volume depletion, sepsis, paraproteinemia, or patient’s receiving known nephrotoxic drugs.
Especially in such patients, IVIG products should be administered at the minimum concentration
available and the minimum rate of infusion practicable. While these reports of renal dysfunction and
acute renal failure have been associated with the use of many of the licensed IVIG products, those
containing sucrose as a stabilizer accounted for a disproportionate share of the total number.
Gamunex and Gammagard do not contain sucrose.

D. Patients are to be monitored closely especially during the infusion, as the administration of IVIG
can be associated with many adverse effects including:
 Flu-like symptoms
 Rash
 Blood pressure instability
 Volume overload
 Anaphylaxis
 Bronchospasm
 Thromboembolic events
 Acute renal failure
 Aseptic meningitis
E. Reactions with subsequent infusions may be prevented/reduced by pretreatment with
acetaminophen, diphenhydramine, and/or corticosteroids.

Responsibility
Medical Staff, Pharmacy, Nursing and other clinical employees.

Other Applicable Policies
None

Updated November 9, 2017 69