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Şorodoc V, Constantin M, Asaftei A, Lionte C, Ceasovschih A, Sîrbu O, Haliga RE, Şorodoc L. The use of intravenous immunoglobulin in the treatment of Hashimoto's encephalopathy: case based review. Front Neurol 2023; 14:1243787. [PMID: 37745658 PMCID: PMC10513043 DOI: 10.3389/fneur.2023.1243787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Background Hashimoto's encephalopathy (HE) is a controversial immunological neuropsychiatric disease, with a poorly understood pathogenesis. It is characterized by symptoms of acute or subacute encephalopathy which usually occur in the presence of elevated levels of antithyroid antibodies. Even though it is also known as steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT), some cases appear to be steroid-resistant. This review examined whether treatment of Hashimoto's encephalopathy with intravenous immunoglobulin (IVIG) is associated with better clinical outcomes than the standard therapy. Additionally, we presented a case of a 59-year-old man who presented with severe neurological manifestations and was successfully treated with intravenous immunoglobulin. Methods The online databases PubMed and EMBASE were searched. Results A total of 1,365 articles were identified. After the deletion of 112 duplicates, 1,253 studies were screened by evaluating the title and abstract, focusing on Hashimoto's encephalopathy cases where IVIG were used. 846 studies were excluded because they were not relevant to the topic or included pediatric population. Therefore, 407 full-text articles were assessed for eligibility. The final analysis included 14 eligible articles after 393 were excluded (irrelevant texts, not written in English, full-text not available). In the majority of the selected case-reports, IVIG was associated with a good outcome, sometimes even with dramatic improvements in patient's status. Conclusion In last years, intravenous immunoglobulin therapy proved its utility in Hashimoto's encephalopathy's treatment, being a well tolerated therapy associated with remarkable improvement in patient's status. Further research is still needed in order to define the optimal treatment protocol for Hashimoto's encephalopathy and to establish if intravenous immunoglobulin can also be used as a first-line therapy, alone or in combination with steroids.
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Affiliation(s)
- Victoriţa Şorodoc
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Iasi, Romania
- Internal Medicine Department, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Mihai Constantin
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Iasi, Romania
- Internal Medicine Department, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Andreea Asaftei
- 2nd Rheumatology Department, Clinical Rehabilitation Hospital, Iasi, Romania
| | - Cătălina Lionte
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Iasi, Romania
- Internal Medicine Department, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Alexandr Ceasovschih
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Iasi, Romania
- Internal Medicine Department, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Oana Sîrbu
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Iasi, Romania
- Internal Medicine Department, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Raluca Ecaterina Haliga
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Iasi, Romania
- Internal Medicine Department, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Laurenţiu Şorodoc
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Iasi, Romania
- Internal Medicine Department, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
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2
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Kapoor M, Hunt I, Spillane J, Bonnett LJ, Hutton EJ, McFadyen J, Westwood JP, Lunn MP, Carr AS, Reilly MM. IVIg-exposure and thromboembolic event risk: findings from the UK Biobank. J Neurol Neurosurg Psychiatry 2022; 93:876-885. [PMID: 35688633 DOI: 10.1136/jnnp-2022-328881] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/28/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Arterial and venous thromboembolic events (TEEs) have been associated with intravenous Ig use, but the risk has been poorly quantified. We aimed to calculate the risk of TEEs associated with exposure to intravenous Ig. METHODS We included participants from UK Biobank recruited over 3 years, data extracted September 2020.The study endpoints were incidence of myocardial infarction, other acute ischaemic heart disease, stroke, pulmonary embolism and other venous embolism and thrombosis.Predictors included known TEE risk factors: age, sex, hypertension, smoking status, type 2 diabetes mellitus, hypercholesterolaemia, cancer and past history of TEE. Intravenous Ig and six other predictors were added in the sensitivity analysis.Information from participants was collected prospectively, while data from linked resources, including death, cancer, hospital admissions and primary care records were collected retrospectively and prospectively. FINDINGS: 14 794 of 502 492 individuals had an incident TEE during the study period. The rate of incident events was threefold higher in those with prior history of TEE (8 .7%) than those without previous history of TEE (3.0%).In the prior TEE category, intravenous Ig exposure was independently associated with increased risk of incident TEE (OR=3.69 (95% CI 1.15 to 11.92), p=0.03) on multivariate analysis. The number needed to harm by exposure to intravenous Ig in those with a history of TEE was 5.8 (95% CI 2.3 to 88.3).Intravenous Ig exposure did not increase risk of TEE in those with no previous history of TEE. INTERPRETATION Intravenous Ig is associated with increased risk of further TEE in individuals with prior history of an event with one further TEE for every six people exposed. In practice, this will influence how clinicians consent for and manage overall TEE risk on intravenous Ig exposure.
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Affiliation(s)
- Mahima Kapoor
- MRC Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK .,Department of Neurosciences, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Ian Hunt
- Tasmanian Institute of Agriculture, University of Tasmania, Hobart, Tasmania, Australia
| | - Jennifer Spillane
- Neurology, Royal Free Hospital Foundation Trust, London, UK.,MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, London, UK
| | | | - Elspeth Jane Hutton
- Neurology, Alfred Health, Melbourne, Victoria, Australia.,Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - James McFadyen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Department of Clinical Hematology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - John-Paul Westwood
- Department of Haematology, University College London Hospital, London, UK
| | - Michael P Lunn
- MRC Centre for Neuromuscular Disease and Department of Molecular Neuroscience, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, UK.,NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Aisling S Carr
- MRC Centre for Neuromuscualr Diseases, National Hospital of Neurology and Neurosurgery, London, UK
| | - Mary M Reilly
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
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Choi EW, Do JY, Kim AY, Kang SH. Renal infarction associated with low dose intravenous immunoglobulin in a kidney transplant recipient with sepsis: a case report and literature review. BMC Nephrol 2021; 22:338. [PMID: 34645393 PMCID: PMC8511279 DOI: 10.1186/s12882-021-02545-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 09/28/2021] [Indexed: 12/29/2022] Open
Abstract
Background The use of human intravenous immunoglobulin gamma (IVIG) is associated with thromboembolic events as a complication. There are few reported cases of renal infarction during IVIG use in the general population, but transplant kidney may be more susceptible to thromboembolic events following IVIG use. Case presentation A 41-year-old woman visited with fever and pain at the transplant kidney. Six years ago, she underwent kidney transplantation from a deceased donor. Laboratory and radiologic findings were compatible to septic condition, secondary to acute pyelonephritis. We started antibiotics, inotropics, and IVIG. The patient abruptly developed gross hematuria and urine output decreased to 100 cc/day during IVIG administration. Renal doppler and pathologic findings revealed renal infarction. Oliguria and azotemia persisted and she is undergoing maintenance hemodialysis. Conclusion Our case shows that infarction of transplant kidney can be caused by IVIG use in a patient with severe infection. Thus, when using IVIG for kidney transplant patients with high risk of thromboembolic events, we may be careful to prevent the thromboembolic events.
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Affiliation(s)
- Eun Woo Choi
- Division of Nephrology, Department of Internal Medicine, Dongkuk University Medical Center, Gyeongju, Republic of Korea
| | - Jun Young Do
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - A Young Kim
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Seok Hui Kang
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea. .,Department of Internal Medicine, Yeungnam University Medical Center, 317-1 Daemyung-Dong, Nam-Ku, Daegu, 705-717, South Korea.
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4
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Thrombosis in Coronavirus disease 2019 (COVID-19) through the prism of Virchow's triad. Clin Rheumatol 2020; 39:2529-2543. [PMID: 32654082 PMCID: PMC7353835 DOI: 10.1007/s10067-020-05275-1] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 02/07/2023]
Abstract
The pathogenesis of Coronavirus disease 2019 (COVID-19) is gradually being comprehended. A high number of thrombotic episodes are reported, along with the mortality benefits of heparin. COVID-19 can be viewed as a prothrombotic disease. We overviewed the available evidence to explore this possibility. We identified various histopathology reports and clinical case series reporting thromboses in COVID-19. Also, multiple coagulation markers support this. COVID-19 can be regarded as a risk factor for thrombosis. Applying the principles of Virchow's triad, we described abnormalities in the vascular endothelium, altered blood flow, and platelet function abnormalities that lead to venous and arterial thromboses in COVID-19. Endothelial dysfunction, activation of the renin-angiotensin-aldosterone system (RAAS) with the release of procoagulant plasminogen activator inhibitor (PAI-1), and hyperimmune response with activated platelets seem to be significant contributors to thrombogenesis in COVID-19. Stratifying risk of COVID-19 thromboses should be based on age, presence of comorbidities, D-dimer, CT scoring, and various blood cell ratios. Isolated heparin therapy may not be sufficient to combat thrombosis in this disease. There is an urgent need to explore newer avenues like activated protein C, PAI-1 antagonists, and tissue plasminogen activators (tPA). These should be augmented with therapies targeting RAAS, antiplatelet drugs, repurposed antiinflammatory, and antirheumatic drugs. Key Points • Venous and arterial thromboses in COVID-19 can be viewed through the prism of Virchow's triad. • Endothelial dysfunction, platelet activation, hyperviscosity, and blood flow abnormalities due to hypoxia, immune reactions, and hypercoagulability lead to thrombogenesis in COVID-19. • There is an urgent need to stratify COVID-19 patients at risk for thrombosis using age, comorbidities, D-dimer, and CT scoring. • Patients with COVID-19 at high risk for thrombosis should be put on high dose heparin therapy.
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5
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Paassen PV, Pittrow D, Scheidegger C, Klotsche J, Ellerbroek PM. Use of recombinant human hyaluronidase-facilitated subcutaneous immunoglobulin in elderly patients. Immunotherapy 2020; 12:131-139. [PMID: 32066296 DOI: 10.2217/imt-2019-0175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aim: Data on the real-world use of hyaluronidase-facilitated subcutaneous 10% immunoglobulin (fSCIG; HyQvia®) in elderly patients with primary or secondary immunodeficiencies (PID or SID) are unreported. This study determined real-world patterns from one administration of fSCIG. Materials & methods: In this retrospective, multicenter study, medical records of patients aged ≥65 years with PID or SID were reviewed. Results: The majority of patients (mean age: 69.9 years) with PID (n = 10) or SID (n = 6) self-administered fSCIG (200-350 ml) at home every 3-4 weeks using a single infusion site by infusion pump at rates up to 300 ml/h. Conclusion: This study provides initial real-world evidence supporting home-based, self-administration of large volumes of fSCIG in elderly patients with PID or SID.
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Affiliation(s)
- Pieter van Paassen
- Department of Internal Medicine, Section Nephrology & Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - David Pittrow
- Institute for Clinical Pharmacology, Technical University, Dresden, Germany
| | | | - Jens Klotsche
- Epidemiology, German Rheumatism Research Center, Berlin, Germany
| | - Pauline M Ellerbroek
- Division of Internal Medicine & Dermatology, Department of Infectious Diseases, University Medical Center, Utrecht, The Netherlands
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6
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Kubota J, Hamano SI, Daida A, Hiwatari E, Ikemoto S, Hirata Y, Matsuura R, Hirano D. Predictive factors of first dosage intravenous immunoglobulin-related adverse effects in children. PLoS One 2020; 15:e0227796. [PMID: 31929600 PMCID: PMC6957294 DOI: 10.1371/journal.pone.0227796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/29/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Intravenous immunoglobulin (IVIG) therapy is used in the treatment of various diseases, and IVIG-related adverse effects (IVIG-AEs) vary from mild to severe. However, the mechanisms underlying IVIG-AEs and the potential predictive factors are not clear. This study investigated whether certain IVIG-AEs can be predicted before IVIG administration. STUDY DESIGN AND METHODS This retrospective cohort study at the Division of Neurology, Saitama Children's Medical Center included patients enrolled from 2008 to 2018 who were < 18 years old and received IVIG for the first time. IVIG-AEs were classified according to the Common Terminology Criteria for Adverse Events version 5.0. RESULTS A total of 104 patients fulfilled the inclusion criteria. The rate of IVIG-AEs was 37.5% (39/104). The most frequent IVIG-AEs were fever (41.0% [16/39]) and headache (38.5% [15/39]). AEs were below grade 2 in all except one patient and there were no grade 4 AEs. High serum total protein (TP) level was significantly related to the occurrence of IVIG-AEs (odds ratio, 14.8; 95% confidence interval, 2.4-90.5; P < 0.01). The optimal cutoff TP level was 6.7 g/dL. Although low WBC count and immunoglobulin G level may be predictive risk factors of IVIG-AEs, it was not confirmed in this study. CONCLUSION IVIG-AEs occurred in 37.5% of cases, and most were mild. TP was the best predictive risk factor of IVIG-AEs before IVIG administration. These results may aid in elucidating the mechanism underlying IVIG-AEs.
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Affiliation(s)
- Jun Kubota
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
- * E-mail:
| | - Shin-ichiro Hamano
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
- Department for Child Health and Human Development, Saitama Children's Medical Center, Saitama, Japan
| | - Atsuro Daida
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
| | - Erika Hiwatari
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Satoru Ikemoto
- Department for Child Health and Human Development, Saitama Children's Medical Center, Saitama, Japan
| | - Yuko Hirata
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
| | - Ryuki Matsuura
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
| | - Daishi Hirano
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
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7
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Graf J, Ingwersen J, Lepka K, Albrecht P, Hartung H, Ringelstein M, Aktas O. Factors associated with headache in intravenous immunoglobulin treatment for neurological diseases. Acta Neurol Scand 2019; 140:290-295. [PMID: 31269227 DOI: 10.1111/ane.13144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/14/2019] [Accepted: 06/27/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify possible risk factors influencing the incidence of intravenous immunoglobulin (IVIg) treatment-related cephalalgia in neurological diseases. MATERIALS & METHODS Retrospective chart review of neurological patients receiving IVIg treatment between July 13, 2017, and August 14, 2017. Patients with MS receiving natalizumab in the same setting were observed as a reference group. RESULTS Patients with headache after IVIg infusion (n = 22 infusions) showed a reduced heart rate (by 6.0 ± 8.5 beats per minute [bpm]), but no significant difference in blood pressure. Patients without headache after IVIg infusion (n = 69 infusions) showed a higher systolic blood pressure increase and a stronger reduction in the heart rate (by 5.7 ± 8.6 bpm), compared to patients with headache after IVIg infusion. The infusion rate was significantly slower and age significantly lower in patients developing headache after IVIg infusion. Body temperature was unchanged in both groups. Binary logistic regression analysis revealed that blood pressure at baseline and age significantly influence the occurrence of cephalalgia. In reference, patients receiving natalizumab (ie, shorter infusions/smaller infusion volume), systolic blood pressure, and heart rate decreased, while body temperature increased. Here, one patient developed headache. CONCLUSIONS Intravenous immunoglobulin-associated headache is not associated with an increased blood pressure after infusion but with a reduced heart rate, a slower infusion rate, female sex and seems to be influenced by baseline systolic blood pressure and age. A reaction to immunoglobulin aggregates, stabilizers, or vasoactive mediators are possible explanations. The absence of an association with body temperature does not suggest a systemic immune response as a cause for headache.
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Affiliation(s)
- Jonas Graf
- Department of Neurology, Medical Faculty Heinrich‐Heine‐University Düsseldorf Germany
| | - Jens Ingwersen
- Department of Neurology, Medical Faculty Heinrich‐Heine‐University Düsseldorf Germany
| | - Klaudia Lepka
- Department of Neurology, Medical Faculty Heinrich‐Heine‐University Düsseldorf Germany
| | - Philipp Albrecht
- Department of Neurology, Medical Faculty Heinrich‐Heine‐University Düsseldorf Germany
| | - Hans‐Peter Hartung
- Department of Neurology, Medical Faculty Heinrich‐Heine‐University Düsseldorf Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty Heinrich‐Heine‐University Düsseldorf Germany
- Department of Neurology, Center for Neurology and Neuropsychiatry LVR‐Klinikum Düsseldorf Düsseldorf Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty Heinrich‐Heine‐University Düsseldorf Germany
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8
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Abbas A, Rajabally YA. Complications of Immunoglobulin Therapy and Implications for Treatment of Inflammatory Neuropathy: A Review. Curr Drug Saf 2019; 14:3-13. [PMID: 30332974 DOI: 10.2174/1574886313666181017121139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Intravenous Immunoglobulin (IVIg) forms a cornerstone of effective treatment for acute and chronic inflammatory neuropathies, with a class I evidence base in Guillain-Barré Syndrome (GBS), Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) and multifocal motor neuropathy (MMN). It is generally considered to be a safe therapy however there are several recognised complications which are reviewed in this article. DISCUSSION AND CONCLUSION Most adverse events are immediate and mild such as headache, fever and nausea although more serious immediate reactions such as anaphylaxis may rarely occur. Delayed complications are rare but may be serious, including thromboembolic events and acute kidney injury, and these and associated risk factors are also discussed. We emphasise the importance of safe IVIg administration and highlight practical measures to minimise complications of this therapy.
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Affiliation(s)
- Ahmed Abbas
- Department of Neurophysiology, Queen Elizabeth Hospital, University Hospital of Birmingham, Birmingham, United Kingdom
| | - Yusuf A Rajabally
- Department of Neurophysiology, Queen Elizabeth Hospital, University Hospital of Birmingham, Birmingham, United Kingdom.,Department of Neurology, Queen Elizabeth Hospital, University Hospital of Birmingham, Birmingham, United Kingdom.,Department of Aston Brain Centre, Aston University, Birmingham, United Kingdom
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9
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Guo Y, Tian X, Wang X, Xiao Z. Adverse Effects of Immunoglobulin Therapy. Front Immunol 2018; 9:1299. [PMID: 29951056 PMCID: PMC6008653 DOI: 10.3389/fimmu.2018.01299] [Citation(s) in RCA: 186] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 05/24/2018] [Indexed: 01/09/2023] Open
Abstract
Immunoglobulin has been widely used in a variety of diseases, including primary and secondary immunodeficiency diseases, neuromuscular diseases, and Kawasaki disease. Although a large number of clinical trials have demonstrated that immunoglobulin is effective and well tolerated, various adverse effects have been reported. The majority of these events, such as flushing, headache, malaise, fever, chills, fatigue and lethargy, are transient and mild. However, some rare side effects, including renal impairment, thrombosis, arrhythmia, aseptic meningitis, hemolytic anemia, and transfusion-related acute lung injury (TRALI), are serious. These adverse effects are associated with specific immunoglobulin preparations and individual differences. Performing an early assessment of risk factors, infusing at a slow rate, premedicating, and switching from intravenous immunoglobulin (IVIG) to subcutaneous immunoglobulin (SCIG) can minimize these adverse effects. Adverse effects are rarely disabling or fatal, treatment mainly involves supportive measures, and the majority of affected patients have a good prognosis.
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Affiliation(s)
- Yi Guo
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China
| | - Xin Tian
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China
| | - Xuefeng Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
| | - Zheng Xiao
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China
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10
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Jung JH, Chae YJ, Lee DH, Cho YI, Ko MM, Park SK, Kim W. Changes in whole blood viscosity during hemodialysis and mortality in patients with end-stage renal disease. Clin Hemorheol Microcirc 2017; 65:285-297. [DOI: 10.3233/ch-16183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Jong Hwan Jung
- Department of Internal Medicine, Divsion of Nephrology, Wonkwang University College of Medicine, Iksan, Republic of Korea
| | - Yoon Jung Chae
- College of Nursing, Chonbuk National University, Jeonju, Republic of Korea
| | - Dong Hwan Lee
- Department of Mechanical Design Engineering, Engineering College, Chonbuk National University, Jeonju, Republic of Korea
| | - Young I. Cho
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Mi Mi Ko
- KM Fundamental Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Sung Kwang Park
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Won Kim
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Republic of Korea
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11
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Management of adverse events in the treatment of patients with immunoglobulin therapy: A review of evidence. Autoimmun Rev 2015; 15:71-81. [PMID: 26384525 DOI: 10.1016/j.autrev.2015.09.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 09/08/2015] [Indexed: 12/12/2022]
Abstract
Immunoglobulin (IG) therapy is actually used for a broad range of diseases including primary and secondary immunodeficiency disorders, and autoimmune diseases. This therapy is available for intravenous (IV) and subcutaneous (SC) administration. The efficacy of the IG therapy has been demonstrated in numerous studies and across different diseases. Generally, IG infusions are well tolerated; however some well-known adverse reactions, ranging from mild to severe, are associated with the therapy. The most common adverse reactions including headache, nausea, myalgia, fever, chills, chest discomfort, skin and anaphylactic reactions, could arise immediately during or after the infusion. Delayed events could be more severe and include migraine headaches, aseptic meningitis, haemolysis renal impairment and thrombotic events. This paper reviews all the potential adverse events related to IG therapy and establishes a comprehensive guideline for the management of these events. Moreover it resumes the opinions and clinical experience of expert endorsers on the utilization of the treatment. Published data were classified into levels of evidence and the strength of the recommendation was given for each intervention according to the GRADE system.
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12
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Yu CF, Hou JF, Shen LZ, Gao K, Rao CM, Yang PY, Fu ZH, Wang QZ, Li YH, Wang L, Liu F, Zhang L, Qu Z, Shen Q, Li B, Li XG, Wang JZ. Acute pulmonary embolism caused by highly aggregated intravenous immunoglobulin. Vox Sang 2015. [PMID: 26198276 DOI: 10.1111/vox.12307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Six patients died and one patient survived following infusion of a specific lot of intravenous immunoglobulin (IVIG) within half an hour in May 2008. This study elucidated the underlying pathogenesis. MATERIALS AND METHODS A variety of protein fractionation and identification approaches were employed to determine the abnormal components in IVIG products obtained from the hospital where the patients were treated. Animal studies using mice and monkeys were conducted to elucidate the pathophysiological mechanisms. In animal experiments, the effect and distribution of immunoglobulin was investigated using HE staining and immunohistochemistry (IHC) separately, while platelets and fibrinogen depletion were utilized to determine a possible link between thromboembolism formation in animals and the lethal effect of the IVIG. The size and distribution of the protein aggregates were determined with Coulter Counter Multisizer-3 after the dilution of the IVIG with plasma, and the lethal effect of the protein aggregates was simulated with artificial microparticles. RESULTS The IVIG retrieved from the hospital was found to have striking similarities to the heat-treated IVIG in terms of protein aggregation profiles and lethal effects. Post-mortem examination indicated that immunoglobulin aggregates were mainly found in the lung of the animals, while depletion of platelets and fibrinogen from the IVIG preparations failed to prevent the death of the animals. Similar amount of artificial microparticles caused animal death in similar fashion. CONCLUSIONS Our findings indicate that the retrieved IVIG exerted its lethal effects by blocking the pulmonary circulation without markedly altering the coagulation cascade or immunological events.
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Affiliation(s)
- C F Yu
- National Institutes for Food and Drug Control, Beijing, China
| | - J F Hou
- National Institutes for Food and Drug Control, Beijing, China
| | - L Z Shen
- National Institutes for Food and Drug Control, Beijing, China
| | - K Gao
- National Institutes for Food and Drug Control, Beijing, China
| | - C M Rao
- National Institutes for Food and Drug Control, Beijing, China
| | - P Y Yang
- National Institutes for Food and Drug Control, Beijing, China
| | - Z H Fu
- National Institutes for Food and Drug Control, Beijing, China
| | - Q Z Wang
- National Institutes for Food and Drug Control, Beijing, China
| | - Y H Li
- National Institutes for Food and Drug Control, Beijing, China
| | - L Wang
- National Institutes for Food and Drug Control, Beijing, China
| | - F Liu
- National Institutes for Food and Drug Control, Beijing, China
| | - L Zhang
- National Institutes for Food and Drug Control, Beijing, China
| | - Z Qu
- National Institutes for Food and Drug Control, Beijing, China
| | - Q Shen
- National Institutes for Food and Drug Control, Beijing, China
| | - B Li
- National Institutes for Food and Drug Control, Beijing, China
| | - X G Li
- Centre for Vaccine Evaluation, Biologics and Genetic Therapies Directorate, HPFB, Health Canada, Ottawa, ON, Canada
| | - J Z Wang
- National Institutes for Food and Drug Control, Beijing, China
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13
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Kissel M, Phoon CKL, Kahn PJ. Hypertension during intravenous immune globulin infusion for Kawasaki's disease: an underreported phenomenon? Clin Pediatr (Phila) 2015; 54:491-3. [PMID: 24899632 DOI: 10.1177/0009922814536776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Colin K L Phoon
- New York University Langone Medical Center, New York, NY, USA
| | - Philip J Kahn
- New York University Langone Medical Center, New York, NY, USA
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14
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Darnige L, Lillo-Le Louët A. [Treatments with immunoglobulin and thrombotic adverse events]. Rev Med Interne 2013; 35:39-44. [PMID: 24011913 DOI: 10.1016/j.revmed.2013.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 05/24/2013] [Accepted: 07/20/2013] [Indexed: 02/06/2023]
Abstract
Treatments with intravenous or subcutaneous immunoglobulin (Ig) are used in a broad variety of disorders. Tolerance of Ig is usually good but adverse events, including some serious ones, have been reported and may differ among different Ig preparations. Thrombotic complications occur in 0.6 to 13% of cases and can involve arterial or venous circulation, rarely both. Deep venous thrombosis with or without pulmonary embolism, stroke or myocardial infarction remained the most frequent thrombotic complications. Some risk factors have been identified, mainly old age, multiple cardiovascular risk factors, and past history of thrombo-embolic manifestations. Several mechanisms are suggested to explain this increased risk of thrombotic complications. Indeed, Ig treatments increase the plasma viscosity, increase and activate platelets, can trigger the coagulation cascade through the presence of activated factor XI in some Ig preparations, and release vasoactive molecules responsible for vasospasm. Patients have to be carefully monitored and risk factors to be identified as soon as possible. The role of antiplatelets or anticoagulation is not well determined but should probably be proposed to patients with high risk.
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Affiliation(s)
- L Darnige
- Service d'hématologie biologique, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75908 Paris cedex 15, France.
| | - A Lillo-Le Louët
- Centre régional de pharmacovigilance, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75908 Paris cedex 15, France
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15
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Zaldívar-López S, Marín LM, Iazbik MC, Westendorf-Stingle N, Hensley S, Couto CG. Clinical pathology of Greyhounds and other sighthounds. Vet Clin Pathol 2011; 40:414-425. [PMID: 22092909 DOI: 10.1111/j.1939-165x.2011.00360.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 07/01/2011] [Accepted: 08/03/2011] [Indexed: 11/28/2022]
Abstract
Owing to the development of Greyhounds as racing sighthounds, these dogs have acquired unique physiologic adaptations that distinguish them from other breeds. Reference intervals for many analytes in retired racing Greyhounds (RRGs) differ from those of other breeds; most of the hematologic differences have also been described in other sighthounds. In this review, we provide a survey of the literature on clinical pathology of Greyhounds and other sighthounds and results of laboratory testing, including analysis of CBCs, biochemical profiles, coagulation tests, and blood gases, in RRGs at The Ohio State University. Major clinicopathologic differences in this breed include higher RBC mass, creatinine concentration, glomerular filtration rate, activities of hepatic enzymes, and concentration of cardiac troponin, as well as lower WBC, neutrophil, and platelet counts, thromboelastographic values, and concentrations of serum haptoglobin, total globulins, and T4.
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Affiliation(s)
- S Zaldívar-López
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA.,Center for Molecular and Human Genetics at The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - L M Marín
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - M C Iazbik
- Veterinary Medical Center, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - N Westendorf-Stingle
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA.,Veterinary Medical Center, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - S Hensley
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - C G Couto
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA.,Veterinary Medical Center, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA.,Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
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