How Does Intravenous Immunoglobulin Work?

Immune globulins are antibodies naturally produced by the body to fight off infection. Intravenous immunoglobulin (IVIG) contains a mixture of immunoglobulins (antibodies) from donor plasma.

Intravenous immunoglobulin (IVIG) is used to treat a wide variety of conditions. Food and Drug Administration (FDA) approved uses for intravenous immunoglobulin include:

• Chronic lymphocytic leukemia
• Common variable immunodeficiency (CVID) 
• Chronic inflammatory demyelinating polyneuropathy (CIDP) 
• Primary immunodeficiency disorders associated with defects in humoral immunity
• Immune-mediated thrombocytopenia
• Kawasaki disease 
• Chronic B-cell lymphocytic leukemia
• Pediatric HIV type 1 infection
• Multifocal motor neuropathy

Off-label (not approved for use by the FDA for the condition) uses for intravenous immunoglobulin include:

• Hematology
• Aplastic anemia
• Pure red cell aplasia
• Diamond-Blackfan anemia
• Autoimmune hemolytic anemia
• Hemolytic disease of the newborn
• Acquired factor VIII inhibitors
• Acquired von Willebrand disease
• Immune-mediated neutropenia
• Refractoriness to platelet transfusion
• Neonatal alloimmune/autoimmune thrombocytopenia
• Posttransfusion purpura
• Thrombotic thrombocytopenia purpura/hemolytic uremic syndrome
• Infectious diseases
• Neurology
• Epilepsy and pediatric intractable Guillain-Barré syndrome
• Chronic inflammatory demyelinating polyneuropathy
• Myasthenia gravis
• Lambert-Eaton myasthenic syndrome
• Multifocal motor neuropathy
• Multiple sclerosis
• Recurrent pregnancy loss
• Pulmonology
• Asthma
• Chronic chest symptoms
• Rheumatology
• Rheumatoid arthritis (adult and juvenile)
• Systemic lupus erythematosus
• Lupus nephritis
• Systemic vasculitides
• Dermatomyositis, polymyositis
• Inclusion-body myositis
• Wegener granulomatosis

Intravenous immunoglobulin (IVIG) liquid products are administered, as the name would imply, intravenously. 

• IVIG is usually administered at a healthcare facility or an infusion center. In some cases, it may be administered in an at-home setting by a trained infusion nurse. 
• Patients should be well hydrated before receiving IVIG infusion to prevent certain complications such as blood clots and kidney problems. 
• Products should be administered at room temperature to minimize adverse effects.
• The dose of IVIG depends on its purpose. 
  • Doses of 400 to 800 mg/kg/month are used to treat immune deficiencies, and may be given every three to four weeks. 
  • Doses ranging from 1-2 g/kg in a single dose are used in patients who need auto-inflammatory effects of IVIG.

Intravenous immunoglobulin (IVIG) provides the body with antibodies it is not producing on its own to help fight infections.

Most side effects of intravenous immunoglobulin (IVIG) are mild and temporary and occur soon after infusion, such as: 

• Headache
• Flushing
• Chills
• Muscle pain 
• Wheezing
• Fast heart rate 
• Lower back pain
• Nausea
• Low blood pressure (hypotension)

Complications of intravenous immunoglobulin (IVIG) include:

• Serious allergic (anaphylactoid) reactions including eczema with itchy blisters
• Acute kidney (renal) failure
• Blood clots (rare)
• Life-threatening human parvovirus B19 infection 
• Life-threatening hepatitis C infection
• Severe inflamed blood vessels in the skin (cutaneous vasculitis)
• Heart attack
• Aseptic meningitis (rare) 
  • Fever
  • Neck stiffness
  • Headache
  • Confusion
  • Nausea
  • Vomiting
• High levels of protein in the blood (hyperproteinemia), increased serum viscosity, and pseudohyponatremia following infusion
• Hair loss