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Sänger F, Dörfelt S, Giani B, Buhmann G, Fischer A, Dörfelt R. Successful Emergency Management of a Dog with Ventilator-Dependent Acquired Myasthenia Gravis with Immunoadsorption. Animals (Basel) 2023; 14:33. [PMID: 38200764 PMCID: PMC10778221 DOI: 10.3390/ani14010033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
A one-year-old, female intact Samoyed, 12.5 kg, was presented with coughing for 2 weeks, progressive appendicular and axial muscle weakness, megaesophagus and labored breathing for 5 days. There was no improvement with standard treatment. Acquired myasthenia gravis was suspected and the dog was referred with increasing dyspnea. At presentation, the dog showed a severely reduced general condition, was non-ambulatory and showed abdominal and severely labored breathing. A marked hypercapnia (PvCO2 = 90.1 mmHg) was present in venous blood gas analysis. The serum anti-acetylcholine receptor antibody test was consistent with acquired myasthenia gravis (2.1 nmol/L). The dog was anesthetized with propofol and mechanically ventilated with a Hamilton C1 ventilator. Immunoadsorption was performed with the COM.TEC® and ADAsorb® platforms and a LIGASORB® adsorber to eliminate anti-acetylcholine receptor antibodies. Local anticoagulation was performed with citrate. Treatment time for immunoadsorption was 1.5 h with a blood flow of 50 mL/min. A total plasma volume of 1.2 L was processed. Further medical treatment included intravenous fluid therapy, maropitant, esomeprazole, antibiotic therapy for aspiration pneumonia and neostigmine 0.04 mg/kg intramuscularly every 6 h for treatment of acquired myasthenia gravis. Mechanical ventilation was stopped after 12 h. A percutaneous gastric feeding tube was inserted under endoscopic control on day 2 for further medical treatment and nutrition. A second treatment with immunoadsorption was performed on day 3. Again, a total plasma volume of 1.2 L was processed. Immediately after this procedure, the dog regained muscle strength and was able to stand and to walk. After 6 days, the dog was discharged from the hospital. This is the first report of immunoadsorption for emergency management of a dog with acute-fulminant acquired myasthenia gravis. Immunoadsorption may be an additional option for emergency treatment in dogs with severe signs of acquired myasthenia gravis.
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Affiliation(s)
- Florian Sänger
- LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Ludwig-Maximilians-Universität München, 80539 Munich, Germany; (F.S.); (B.G.); (G.B.); (A.F.)
| | | | - Bettina Giani
- LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Ludwig-Maximilians-Universität München, 80539 Munich, Germany; (F.S.); (B.G.); (G.B.); (A.F.)
| | - Gesine Buhmann
- LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Ludwig-Maximilians-Universität München, 80539 Munich, Germany; (F.S.); (B.G.); (G.B.); (A.F.)
| | - Andrea Fischer
- LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Ludwig-Maximilians-Universität München, 80539 Munich, Germany; (F.S.); (B.G.); (G.B.); (A.F.)
| | - René Dörfelt
- LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Ludwig-Maximilians-Universität München, 80539 Munich, Germany; (F.S.); (B.G.); (G.B.); (A.F.)
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Tocut M, Kolitz T, Shovman O, Haviv Y, Boaz M, Laviel S, Debi S, Nama M, Akria A, Shoenfeld Y, Soroksky A, Zandman-Goddard G. Outcomes of ICU patients treated with intravenous immunoglobulin for sepsis or autoimmune diseases. Clin Exp Rheumatol 2022; 21:103205. [PMID: 36195246 DOI: 10.1016/j.autrev.2022.103205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/28/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To evaluate the outcomes of hospitalized patients in two intensive care units (ICU) treated with intravenous immunoglobulin (IVIg) added to standard-of-care therapy. The indications for IVIg therapy were sepsis or autoimmune disease. METHODS We conducted a retrospective study involving adult patients with sepsis and autoimmune diseases, who received IVIg in the ICU at Wolfson and Sheba Medical Centers. A predefined chart was compiled on Excel to include a complete demographic collection, patient comorbidities, chronic medication use, disease severity scores (Charlson Comorbidity Index; SOFA and APACHE II index scores), indication and dosage of IVIg administration, duration of hospitalization and mortality rates. RESULTS Patients (n - 111) were divided into 2 groups: patients with sepsis only (n-67) and patients with autoimmune disease only (n-44). Septic patients had a shorter ICU stay, received IVIg early, and had reduced mortality if treated with high dose IVIg. Patients with autoimmune diseases did not have a favorable outcome despite IVIg treatment. In this group, IVIg was administered later than in the sepsis group. CONCLUSIONS IVIg therapy improved the outcomes for ICU patients with sepsis.
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Affiliation(s)
- Milena Tocut
- Department of Medicine C, Wolfson Medical Center, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel; The Center for Autoimmune Diseases
| | - Tamara Kolitz
- Sackler Faculty of Medicine, Tel-Aviv University, Israel; Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center
| | - Ora Shovman
- Sackler Faculty of Medicine, Tel-Aviv University, Israel; The Center for Autoimmune Diseases; Department of Medicine B
| | - Yael Haviv
- Sackler Faculty of Medicine, Tel-Aviv University, Israel; Intensive Care Unit, Sheba Medical Center, Israel
| | - Mona Boaz
- Nutrition Sciences Department, Ariel University, Israel
| | - Shira Laviel
- Department of Medicine C, Wolfson Medical Center, Israel
| | - Stav Debi
- Department of Medicine C, Wolfson Medical Center, Israel
| | - Mona Nama
- Department of Medicine C, Wolfson Medical Center, Israel
| | - Amir Akria
- Department of Medicine C, Wolfson Medical Center, Israel
| | - Yehuda Shoenfeld
- Sackler Faculty of Medicine, Tel-Aviv University, Israel; The Center for Autoimmune Diseases; Ariel University, Ariel, Israel; I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Arie Soroksky
- Sackler Faculty of Medicine, Tel-Aviv University, Israel; Intensive Care Unit, Wolfson Medical Center, Israel
| | - Gisele Zandman-Goddard
- Department of Medicine C, Wolfson Medical Center, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel.
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Spurlock N, Prittie J. Use of Human Intravenous Immunoglobulin in Veterinary Clinical Practice. Vet Clin North Am Small Anim Pract 2021; 50:1371-1383. [PMID: 32896436 DOI: 10.1016/j.cvsm.2020.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Therapy with human intravenous immunoglobulin (hIVIG) as an immunomodulator in veterinary patients results in effective but transient immunosuppression, and may be viable as part of a multidrug strategy against immune-mediated thrombocytopenia and autoimmune cutaneous disease. Efficacy of hIVIG against other veterinary autoimmune diseases is questionable. Veterinary patients tolerate hIVIG therapy well, with few infusion reactions documented. Veterinary clinical trials of hIVIG are limited, and more work is needed to determine the true efficacy and risk of hIVIG administration in companion animals.
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Affiliation(s)
- Nicole Spurlock
- Animal Specialty Emergency Center, 1535 South Sepulveda, Los Angeles, CA 90025, USA.
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Single-Center Experience of Outcomes and Prescribing Patterns of IV Immunoglobulin Use in Critically Ill Patients. Crit Care Explor 2021; 3:e0314. [PMID: 33458682 PMCID: PMC7803672 DOI: 10.1097/cce.0000000000000314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. Previous literature has not compared prescribing practices of IV immunoglobulin in medical ICU survivors and nonsurvivors. The objective of this study was to study IV immunoglobulin use in patients admitted to a medical ICU evaluating differences between hospital survivors and nonsurvivors in regards to level of evidence supporting use, prescribing patterns, and cost.
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Ramos SJ, Beale VM, Langohr IM, Woodward MC. Erythema Multiforme Major in a Dog Treated with Intravenous Human Immunoglobulin and Immunosuppressive Therapy. J Am Anim Hosp Assoc 2020; 56:133-138. [PMID: 31961218 DOI: 10.5326/jaaha-ms-6896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An ∼12 yr old castrated mixed-breed dog was evaluated for a 7 wk progressive history of intermittent hyporexia, lethargy, and erosive dermatitis. Initial examination revealed disseminated papules and macules coalescing to irregularly shaped and serpiginous plaques with widespread erosion progressing to ulceration. Skin histopathology revealed transepidermal keratinocyte apoptosis with lymphocyte satellitosis and lymphocytic and histiocytic interface infiltrate. Histopathology combined with clinical signs and history were compatible with the diagnosis of erythema multiforme major. Treatment was initiated with multidrug immunosuppression. Following 36 hr with no improvement, intravenous human immunoglobulin (0.45 mg/kg IV) was administered resulting in notable improvement in the dog's attitude and appetite within 2 hr and the dog's skin lesions within 48 hr. Following discharge, the dog improved daily with near complete resolution of dermatologic disease achieved 1 mo postdischarge. All immunosuppressive medications were ultimately discontinued 5 mo following presentation. This is the first report of a dog with erythema multiforme major that has been successfully treated with a combination of intravenous immunoglobulin and immunosuppression.
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Affiliation(s)
- Sara J Ramos
- From the Department of Veterinary Clinical Sciences (S.J.R., V.M.B., M.C.W.), and Department of Pathobiological Sciences (I.M.L.), School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana
| | - Victoria M Beale
- From the Department of Veterinary Clinical Sciences (S.J.R., V.M.B., M.C.W.), and Department of Pathobiological Sciences (I.M.L.), School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana
| | - Ingeborg M Langohr
- From the Department of Veterinary Clinical Sciences (S.J.R., V.M.B., M.C.W.), and Department of Pathobiological Sciences (I.M.L.), School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana
| | - Michelle C Woodward
- From the Department of Veterinary Clinical Sciences (S.J.R., V.M.B., M.C.W.), and Department of Pathobiological Sciences (I.M.L.), School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana
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Madsen MB, Bergsten H, Norrby-Teglund A. Treatment of Necrotizing Soft Tissue Infections: IVIG. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1294:105-125. [DOI: 10.1007/978-3-030-57616-5_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Elajez R, Ezzeldin A, Gaber H. Safety evaluation of intravenous immunoglobulin in pediatric patients: a retrospective, 1-year observational study. Ther Adv Drug Saf 2019; 10:2042098619876736. [PMID: 31620272 PMCID: PMC6777049 DOI: 10.1177/2042098619876736] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 08/26/2019] [Indexed: 11/17/2022] Open
Abstract
Background: Intravenous immunoglobulin (IVIG) is a pooled human plasma protein that has
shown efficacy in treating a variety of disorders. IVIG is generally well
tolerated and has a good safety profile. There are various IVIG products
available on the market, which results in differences in efficacy and safety
profile. The aim of this study was to assess the safety profile of IVIG use
in pediatric patients and its association with other predicted factors. Methods: Retrospective chart review study of all pediatric patients who received IVIG
as an inpatient at Hamad General Hospital in Qatar during 2014. The
occurrence of adverse drug reactions (ADR) was tested for any association
with other predicted factors, such as patient age, IVIG dose, brand, and
adherence to infusion protocol. Results: A total of 345 IVIG prescriptions were received by pediatric patients during
the study period. Most common documented side effects were: fever (5.8%),
chills (2.6%), and headache (2%). Renal insufficiency was observed only in
six cases, with five of those in ‘Risk’ category according to RIFLE
criteria. A hypersensitivity reaction was documented in seven patients,
despite being premedicated with paracetamol and/or diphenhydramine and
following the infusion protocol. None of the predicted factors were found to
be significantly associated with ADR incidence except IVIG brand. Conclusions: IVIG generally has a good safety profile in pediatric patients, with low risk
of severe ADR. More studies are needed to evaluate the correlation between
ADR and IVIG formulation, taking into account other factors that may affect
results.
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Affiliation(s)
- Reem Elajez
- Hamad Medical Corp, P.O Box 3050, Doha, Qatar
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El Ajez RH, Mohamed AE, Gaber Ali H. Evidence-based evaluation of intravenous immunoglobulin utilization in paediatric patients in Qatar. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2019. [DOI: 10.1111/jphs.12285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fakhari Z, Farsaei S, Sabzghabaee AM. Predicting Factors for the Pattern of Intravenous Immunoglobulin Utilization in a Middle Eastern University Hospital. J Res Pharm Pract 2018; 7:188-194. [PMID: 30622986 PMCID: PMC6298141 DOI: 10.4103/jrpp.jrpp_18_73] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: The dramatic increase in the consumption of intravenous immunoglobulin (IVIG) products in nonapproved indications, its high cost, and the severe shortage has developed the concerns of its irrational utilization, especially in the Middle East countries. Therefore, this clinical study attempts to describe the pattern of IVIG administration in one of the largest hospitals in Iran and find the variables associated with inappropriate IVIG utilization. Methods: This cross-sectional medication utilization study was conducted in one of the largest referral hospitals in Iran. Random IVIG administrations were assessed from different wards for 9 months. Different data were collected to evaluate the pattern of IVIG administration and find variables, which could predict this behavior. Findings: IVIG was prescribed for approved indications in 72% of 201 patients recruited in our study. Although, the rate of drug administration was appropriate in most of the study population, hydration and pre-medication were unsuitable in more than one-third of the patients. Among the variables analyzed to find the factors affecting the misuse of IVIG, female gender, older age of patients, and longer time to start IVIG administration due to hospital admission were statistically significant in the multivariate model. Conclusion: Despite the fact that inappropriate use of IVIG was confirmed in less than 30 % of its utilization for the studied patients, it caused a potential risk of treatment complications and a notable and unjustifiable burden of unnecessary costs for this University hospital.
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Affiliation(s)
- Zeinab Fakhari
- Pharmacy Students' Research Committee, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shadi Farsaei
- Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Mohammad Sabzghabaee
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Harbrecht BG, Nash NA. Necrotizing Soft Tissue Infections: A Review. Surg Infect (Larchmt) 2016; 17:503-9. [DOI: 10.1089/sur.2016.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Brian G. Harbrecht
- The Hiram C. Polk, Jr. MD Department of Surgery and the Price Institute for Surgical Research, University of Louisville, Louisville, Kentucky
| | - Nick A. Nash
- The Hiram C. Polk, Jr. MD Department of Surgery and the Price Institute for Surgical Research, University of Louisville, Louisville, Kentucky
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Prognostic factors and efficacy of human intravenous immunoglobulin G in dogs with idiopathic immune-mediated hemolytic anemia: a retrospective study. ACTA ACUST UNITED AC 2016. [DOI: 10.14405/kjvr.2016.56.3.139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Koch C, Hecker A, Grau V, Padberg W, Wolff M, Henrich M. Intravenous immunoglobulin in necrotizing fasciitis - A case report and review of recent literature. Ann Med Surg (Lond) 2015; 4:260-3. [PMID: 26288730 PMCID: PMC4539184 DOI: 10.1016/j.amsu.2015.07.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/30/2015] [Accepted: 07/30/2015] [Indexed: 11/24/2022] Open
Abstract
Introduction Necrotizing fasciitis (NF) is an inflammatory disease of the soft tissue, which causes local tissue destruction and can lead to lethal septic shock. The therapy consists of early surgical treatment of the septic focus and an accompanying broad spectrum antibiotic therapy. Recent literature considers the additional use of immunoglobulin therapy in severe soft skin and tissue infections. Presentation of case In this report, we describe the case of a 33-year-old male patient treated at a university hospital intensive care unit because of an NF of his left leg. The patient rapidly developed a complicated septic disease after a minor superficial trauma. Despite intense microbiological diagnosis, no causative pathogens were identified. After non-responding to established broad anti-infective treatment, the patient received intravenous immunoglobulin, that rapidly improved his clinical condition. Discussion NF represents a disease processes, which is characterized by fulminant, widespread necrosis of soft tissue, systemic toxicity, and high mortality (>30%). Beside the surgical debridement and broad spectrum antibiotic therapy IVIg therapy might be an additional option in the treatment of NF. But the current literature supporting the use of IVIG in NF is largely based on retrospective or case-controlled studies, and only small randomized trials. Conclusion The demonstrated case suggests that IVIg treatment of patients with NF can be considered in case of hemodynamic unstable, critically ill patients. Although randomized controlled trials are missing, some patients might benefit from diminishing hyperinflammation by immunoglobins. Necrotizing fasciitis (NF) is an inflammatory disease, which causes local tissue destruction up to lethal septic shock. We describe the case of a 33-year-old male patient representing an NF of his left leg. After non-responding to established broad anti-infective treatment, the patient received immunoglobulin (IVIg). The presented case suggests that IVIg treatment of patients with NF might be considered in case of critically ill patients.
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Affiliation(s)
- C Koch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg, 35392 Giessen, Germany
| | - A Hecker
- Department General and Thoracic Surgery, University Hospital of Giessen and Marburg, 35392 Giessen, Germany
| | - V Grau
- Department General and Thoracic Surgery, University Hospital of Giessen and Marburg, 35392 Giessen, Germany
| | - W Padberg
- Department General and Thoracic Surgery, University Hospital of Giessen and Marburg, 35392 Giessen, Germany
| | - M Wolff
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg, 35392 Giessen, Germany
| | - M Henrich
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg, 35392 Giessen, Germany
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Abstract
OBJECTIVE To assess the safety profile of intravenous immunoglobulin (IVIG) and plasma exchange (PLEX) when used to treat critically ill patients. METHODS We performed a retrospective analysis of consecutive patients who received IVIG or PLEX while admitted to our medical intensive care unit (ICU), neuroscience ICU or haematologic/oncologic ICU between 2007 and 2011.Patients who were transferred into an ICU while receiving therapy or who continued therapy after discharge from the ICU were included in the analysis. RESULTS A total of 118 consecutive patients were included in the study. Fifty-nine patients received IVIG. Twenty of these patients (34%) developed renal failure during the hospitalisation, including 15 (25.4%) in whom renal function worsened during or shortly after IVIG administration and 4 (6.8%) in whom IVIG was considered a possible cause. Transfusion reactions occurred in five patients (8%). Seven patients (12%) did not receive the full intended course of IVIG. Thirty-four patients (58%) who received IVIG died during their hospitalisation. Fifty-nine patients received PLEX. Hypotension requiring an intervention was noted with 39 sessions (8.5%) and led to discontinuation of the session in 11 (2.4%). Other adverse events included line-related infections (n = 4), pneumothorax (n = 4) and electrolyte abnormalities and transfusion reactions (n = 10). Six patients (10%) did not receive full intended treatment course of PLEX. Nineteen patients (32%) treated with PLEX died during their hospitalisation. DISCUSSION Intravenous immunoglobulin and PLEX are generally well tolerated by critically ill patients. Intravenous immunoglobulin was associated with worsening renal function in one-quarter of patients.
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Intravenous immunoglobulin in critically ill adults: When and what is the evidence? J Crit Care 2015; 30:652.e9-16. [PMID: 25702845 DOI: 10.1016/j.jcrc.2015.01.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/20/2015] [Accepted: 01/30/2015] [Indexed: 02/07/2023]
Abstract
Intravenous immunoglobulin (IVIg) use is growing dramatically internationally due to the increasing numbers of acute and chronic conditions that may benefit from IVIg. Patients with conditions that may benefit from IVIg might require intensive care unit (ICU) admission, supporting the need to review IVIg use in the critical care setting. The most common clinical indications for IVIg in adults that may require ICU admission and are commonly supported under clinical practice guidelines are Guillain-Barré syndrome, myasthenia gravis and Lambert-Eaton myasthenic syndrome, inflammatory myopathies, and primary or secondary immunodeficiency diseases complicated by severe bacterial sepsis. Other emerging indications include necrotizing fasciitis, toxic epidermal necrolysis/Stevens-Johnson syndrome, and toxic shock syndrome. The evidence for IVIg use in sepsis and septic shock remains controversial and insufficient to recommend its routine use. Intravenous immunoglobulin is expensive and also carries risks of adverse effects, including common and benign infusion-related reactions, as well as relatively rare and more serious problems, such as thromboembolic events, renal failure, and aseptic meningitis. In this article, we review the literature on conditions requiring ICU admission and IVIg, and we classify them as supported, emerging, or unsupported indications based on the available evidence and guidelines for clinical use of IVIg.
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Optimal attenuation of experimental autoimmune encephalomyelitis by intravenous immunoglobulin requires an intact interleukin-11 receptor. PLoS One 2014; 9:e101947. [PMID: 25078447 PMCID: PMC4117465 DOI: 10.1371/journal.pone.0101947] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 06/12/2014] [Indexed: 01/29/2023] Open
Abstract
Background Intravenous immunoglobulin (IVIg) has been used to treat a variety of autoimmune disorders including multiple sclerosis (MS); however its mechanism of action remains elusive. Recent work has shown that interleukin-11 (IL-11) mRNAs are upregulated by IVIg in MS patient T cells. Both IVIg and IL-11 have been shown to ameliorate experimental autoimmune encephalomyelitis (EAE), an animal model of MS. The objective of this study was to determine whether the protective effects of IVIg in EAE occur through an IL-11 and IL-11 receptor (IL-11R)-dependent mechanism. Methods We measured IL-11 in the circulation of mice and IL-11 mRNA expression in various organs after IVIg treatment. We then followed with EAE studies to test the efficacy of IVIg in wild-type (WT) mice and in mice deficient for the IL-11 receptor (IL-11Rα−/−). Furthermore, we evaluated myelin-specific Th1 and Th17 responses and assessed spinal cord inflammation and demyelination in WT and IL-11Rα−/− mice, with and without IVIg treatment. We also examined the direct effects of mouse recombinant IL-11 on the production of IL-17 by lymph node mononuclear cells. Results IVIg treatment induced a dramatic surge (>1000-fold increase) in the levels of IL-11 in the circulation and a prominent increase of IL-11 mRNA expression in the liver. Furthermore, we found that IL-11Rα−/− mice, unlike WT mice, although initially protected, were resistant to full protection by IVIg during EAE and developed disease with a similar incidence and severity as control-treated IL-11Rα−/− mice, despite initially showing protection. We observed that Th17 cytokine production by myelin-reactive T cells in the draining lymph nodes was unaffected by IVIg in IL-11Rα−/− mice, yet was downregulated in WT mice. Finally, IL-11 was shown to directly inhibit IL-17 production of lymph node cells in culture. Conclusion These results implicate IL-11 as an important immune effector of IVIg in the prevention of Th17-mediated autoimmune inflammation during EAE.
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Lai SW, Huang TC, Ye RH, Wu YY. Necrotizing fasciitis in two patients with myelodysplastic syndrome treated with azacitidine. Eur J Haematol 2014; 94:273-6. [DOI: 10.1111/ejh.12365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Shiue-Wei Lai
- Division of Hematology and Oncology; Department of Internal Medicine; Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
| | - Tzu-Chuan Huang
- Division of Hematology and Oncology; Department of Internal Medicine; Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
| | - Ren-Hua Ye
- Division of Hematology and Oncology; Department of Internal Medicine; Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
| | - Yi-Ying Wu
- Division of Hematology and Oncology; Department of Internal Medicine; Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
- Graduate Institute of Life Sciences; National Defense Medical Center; Taipei Taiwan
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Sridhar G, Ekezue BF, Izurieta HS, Selvam N, Ovanesov MV, Divan HA, Liang Y, Golding B, Forshee RA, Anderson SA, Menis M. Immune globulins and same-day thrombotic events as recorded in a large health care database during 2008 to 2012. Transfusion 2014; 54:2553-65. [DOI: 10.1111/trf.12663] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 02/03/2014] [Accepted: 02/25/2014] [Indexed: 01/01/2023]
Affiliation(s)
| | | | - Hector S. Izurieta
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
| | | | - Mikhail V. Ovanesov
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
| | | | - Yideng Liang
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
| | - Basil Golding
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
| | - Richard A. Forshee
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
| | - Steven A. Anderson
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
| | - Mikhail Menis
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
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Autoimmune diseases in the intensive care unit. An update. Autoimmun Rev 2013; 12:380-95. [DOI: 10.1016/j.autrev.2012.06.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 06/12/2012] [Indexed: 12/18/2022]
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Spurlock NK, Prittie JE. A review of current indications, adverse effects, and administration recommendations for intravenous immunoglobulin. J Vet Emerg Crit Care (San Antonio) 2012; 21:471-83. [PMID: 22316195 DOI: 10.1111/j.1476-4431.2011.00676.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To review and summarize the body of literature regarding human intravenous immunoglobulin (hIVIG) therapy in veterinary medicine. Mechanism of action, usage in human medicine, adverse effects of therapy, implications for veterinary use, and administration recommendations are discussed. DATA SOURCES Current human and veterinary peer-reviewed medical literature including original research articles and scientific reviews. HUMAN DATA SYNTHESIS There are currently 6 labeled uses for hIVIG in human medicine, but preparations are used off-label to successfully treat multiple immune-mediated conditions. To maximize the potential of hIVIG use in animals and identify areas deficient in research, a review of the current literature is warranted. VETERINARY DATA SYNTHESIS Investigation of hIVIG therapy in veterinary patients has been limited to the subjects of immune-mediated hemolytic anemia (IMHA), immune-mediated thrombocytopenia (ITP), Evan's syndrome, cutaneous disease, myasthenia gravis (MG), and sudden acquired retinal degeneration (SARDS). Proponents of veterinary hIVIG use believe administration may reduce transfusion requirements and decrease hospitalization time. CONCLUSION Immunoglobulin (Ig) has not been shown to decrease transfusion requirements in IMHA patients, but shows great promise for treatment of ITP and dermatological diseases. Although serial transfusion of hIVIG is employed in human medicine, repeated transfusion is not recommended in animals due to risk of severe allergic reaction. Other potential adverse effects of transfusion include delayed hypersensitivity reactions, thromboembolism, renal failure, hypotension, and aseptic meningitis.
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Affiliation(s)
- Nicole K Spurlock
- Department of Emergency and Critical Care, The Animal Medical Center, New York, NY 10065, USA.
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Daniel GW, Menis M, Sridhar G, Scott D, Wallace AE, Ovanesov MV, Golding B, Anderson SA, Epstein J, Martin D, Ball R, Izurieta HS. Immune globulins and thrombotic adverse events as recorded in a large administrative database in 2008 through 2010. Transfusion 2012; 52:2113-21. [DOI: 10.1111/j.1537-2995.2012.03589.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Baxley A, Akhtari M. Hematologic toxicities associated with intravenous immunoglobulin therapy. Int Immunopharmacol 2011; 11:1663-7. [DOI: 10.1016/j.intimp.2011.07.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 07/26/2011] [Accepted: 07/27/2011] [Indexed: 11/27/2022]
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