Intravenous immunoglobulin (IVIG)

What is IVIG?

IVIG is a blood product. It is made up of immunoglobulins, which are also called antibodies, that have been donated by thousands of people to make a concentrated formula. Antibodies help protect the body from germs, such as viruses. Antibodies are made by the immune system. The immune system is the part of the body that helps fight infection.

IVIG is sometimes called Gamma.

What is IVIG used for?

IVIG is given to patients with diseases that affect the immune system. Children who do not have enough antibodies are given IVIG to help boost their immune system.

IVIG is also used to treat diseases that happen when the immune system attacks the person's own body. These are called autoimmune disorders.

IVIG is given to your child through an IV

The word "intravenous" (IV) means the IVIG is given directly into your child's vein. A soft flexible tube will be put into a vein in your child’s hand or arm using a needle. The IVIG will then be given slowly to your child through the tube.

Your child may need to stay in the hospital overnight to take the IVIG, or your child may need to come to the hospital just for the day. This depends on what condition the IVIG is treating.

It usually takes between two and six hours to give your child IVIG, but it may take longer. This depends on your child's weight, the type of IVIG used and if your child has any reactions to the IVIG.

A nurse will check on your child as the IVIG is given

Your child will be given IVIG very slowly at first. The nurse will measure your child's temperature, heart rate, breathing rate, and blood pressure. These are called vital signs. If they stay within the normal range and your child has no side effects or problems, the nurse will gradually increase the flow of IVIG.

While the IVIG is being administered, the nurse will keep checking your child's vital signs. If your child has any side effects, the nurse will give the IVIG more slowly or stop it. Vital signs will be checked every 15 minutes in the beginning until your child is getting the fastest flow of IVIG with no side effects.

How long does it take to work?

Depending on the reason your child is receiving IVIG, improvements are often seen within 24 to 48 hours.

Side effects from IVIG are usually mild

In general, IVIG is a safe treatment. Most side effects are mild and easy to control. They do not cause problems that last for a long time. A few patients have more serious side effects, but these are very rare. Talk to your child's doctor about the benefits and risks of IVIG and its possible side effects.

The most common side effects of IVIG

Some children have side effects when they take IVIG. Side effects can happen while the IVIG is going in and up to two days after.

Call your child's nurse or doctor if your child has any of these side effects:

• headache
• fast heart rate
• dizziness or feeling light-headed
• backache
• flushing of face
• nausea or feeling sick to the stomach
• stomach pain
• throwing up
• muscle pain or tenderness
• tightness in the chest or wheezing
• rash or hives
• chills or feeling cold
• fever

Side effects can often be stopped or reduced

If your child has any side effects, you or your child should tell the nurse. Side effects can often be reduced or stopped if the IVIG is given more slowly. Sometimes, other medicines can also help reduce the side effects.

If your child has had problems with IVIG before, the doctor may prescribe medicine for your child before the IVIG is started.

Severe side effects to IVIG are rare

Some children may have a severe side effect called an anaphylactic reaction. This is very rare. It usually happens right after starting the IVIG.

If your child has an anaphylactic reaction, they will have some or all of the following signs and symptoms. Tell your child's nurse right away if you notice your child having any:

• trouble breathing and tightness in the chest
• fever
• flushing and swelling of the face
• feeling sick to the stomach
• dizziness
• throwing up
• rash or hives

Rare, severe reactions to IVIG

A very small number of patients have other, more severe reactions to IVIG. Most of these slowly go away after the IVIG is stopped.

These reactions are described below. If you notice any of these signs or symptoms in your child after you have gone home, call your child's doctor right away. If the signs or symptoms are severe, bring your child to the nearest emergency department.

Hemolytic anemia

Some children experience a drop in the number of red blood cells and hemoglobin after IVIG. This improves over time and rarely needs any treatment. Children with hemolytic anemia get repeat blood tests to monitor their hemoglobin.

These are some signs of hemolytic anemia:

• pale skin
• yellowish skin, eyes and mouth (jaundice)
• dark-coloured urine (pee)
• fever
• feeling weak, dizzy or confused
• fast heart rate

Aseptic meningitis

Aseptic meningitis is a swelling of the outer covering of the brain. "Aseptic" means it is not caused by an infection. Aseptic meningitis usually happens after all the IVIG has gone in and can happen up to 48 hours after your child starts taking it.

These are some signs of aseptic meningitis:

• fever
• severe headache
• neck stiffness
• feeling sick to the stomach
• throwing up
• sensitivity to light
• being less alert

Most patients recover within a few days and tolerate subsequent treatment.

Hyperviscosity syndrome

In hyperviscosity syndrome, the blood becomes thick and does not flow through the body as quickly as usual.

These are some symptoms of hyperviscosity syndrome:

• headache
• fatigue or tiredness
• blurred vision

Kidney failure

In kidney failure, the kidneys stop working properly. Kidney failure is most likely to happen in children who have had kidney problems before.

These are some signs of kidney failure:

• your child cannot urinate (pee)
• your child's urine is much darker than usual

Very little risk of infection from IVIG

IVIG goes through several steps to make sure it is safe and will not cause infection.

• All people who give blood are screened to find out if they might have an infection or other disease.
• All blood is tested for serious infections, such as HIV and hepatitis.
• IVIG is treated to kill most viruses and bacteria before it is given to patients.

You cannot donate blood specifically for your child's treatment

It takes blood from thousands of donors to make the IVIG to give your child.

IVIG may affect how some vaccines work and when they should be given

This section does not apply to children getting regular IVIG for an antibody deficiency. In this situation, discuss any vaccinations with your child’s doctor.

If your child needs a vaccine after having IVIG, talk to your child's doctor about the best time to have it.

• If your child needs live viral vaccines such as the measles, mumps and rubella (MMR) vaccine, MMR-V or varicella (chicken pox) vaccine, these vaccines should be delayed for several months (approximately 7 to 11 months) after IVIG treatment. The actual length of delay depends on the dose of IVIG that your child received.
• If your child had any of these vaccines less than 14 days before having IVIG, then the vaccine should be given again after the suggested waiting time.
• Your child should have all other immunizations as usual.

References

Blood products, human immunoglobulin and timing of immunization: Canadian Immunization Guide. Health Canada. Retrieved from https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-1-key-immunization-information/page-11-blood-products-human-immune-globulin-timing-immunization.html.

Intravenous Immunoglobulin (IVIG) is given in hospital. Please speak with your child's health-care provider if you have concerns regarding their dosage.