Immunoglobulin, high-dose

Patients with IgA nephropathy have abnormal production of IgA and several different immunoglobulins. High-dose immunoglobulins, initially administered intravenously followed by the intramuscular route, for over 9 months arrested the decline of renal function and reduced hematuria and proteinuria in aU of the 11 patients evaluated. The efficacy of this regimen must be confirmed in a larger number of patients before it is used as primary therapy. 

IGIV in high doses (2 g/kg) has proved effective in a variety of different conditions ranging from immunoglobulin deficiencies to... 

Delire M. Different modes of action of high-dose immunoglobulins in rheumatoid arthritis. Acta Univ Carol [Med] (Praha) 1994 40(l-4) 95-9. 

Plasmocytoma Extramedullary plasmocytic lymphoma likewise has its origin in immunoglobulin-secreting B-lymphocytes. It is also termed multiple myeloma. The condition occurs most frequently in 7 decade of life and ends fatally after 1-2 (-3) years. In the liver, there are sometimes sinusoidal and portal infiltrations of B-lym-phocytes and plasmocytic tumour cells nodular formation can also occur. Generally, however, liver involvement is found in 40% of cases. (47, 61) (s. fig. 38.12) Recently, patients with non-response or relapse after high-dose chemotherapy were treated successfully with thalidomide (starting with 200 mg daily, the dose was increased by 200 mg every two weeks until it reached 800 mg per day). (48, 56) Plasma cell leukaemia is a rare complicative variant which tends to have its own individual course. 

Intravenous immunoglobulin expands the plasma volume and increases blood viscosity, which can lead to volume overload in patients with cardiac insufficiency (41). Stroke, thromboembolic events, and myocardial infarction have been reported after high-dose treatment with intravenous immunoglobulin, which increases plasma viscosity (41 3). 

High-dose immunoglobulin has been reported to cause neutropenia (31,73,74), disseminated intravascular coagulation and serum sickness (75). Neutropenia after intravenous immunoglobulin is frequent and seems to be transient and self-limiting (76). Neutropenia is not dose-related in the therapeutic range of doses. 

Jolles S, Hughes J, Rustin M. The treatment of atopic dermatitis with adjunctive high-dose intravenous immunoglobulin a report of three patients and review of the literature. Br J Dermatol 2000 142(3) 551. ... 

Reinhart WH, Berchtold PE. Effect of high-dose intravenous immunoglobulin therapy on blood rheology. Lancet 1992 339(8794) 662-4. 

Sztajzel R, Le Floch-Rohr J, Eggimann P. High-dose intravenous immunoglobulin treatment and cerebral vasospasm A possible mechanism of ischemic encephalopathy Eur Neurol 1999 41(3) 153-8. 

Stangel M, Muller M, Marx P. Adverse events during treatment with high-dose intravenous immunoglobulins for neurological disorders. Eur Neurol 1998 40(3) 173-4. 

Nakagawa M, Watanabe N, Okuno M, Kondo M, Okagawa H, Taga T. Severe hemolytic anemia following high-dose intravenous immunoglobulin administration in a patient with Kawasaki disease. Am J Hematol 2000 63(3) 160-1. 

Elkayam O, Paran D, Milo R, Davidovitz Y, Almoznino-Sarafian D, Zeltser D, Yaron M, Caspi D. Acute myocardial infarction associated with high dose intravenous immunoglobulin infusion for autounmnne disorders. A study of four cases. Ann Rhenm Dis 2000 59(1) 77-80. 

Jolles S, Hughes J, Whittaker S. Dermatological uses of high-dose intravenous immunoglobulin. Arch Dermatol 1998 134(l) 80-6. 

Liver transplantation was considered as an ultimate choice for the patients with HCC, but this is problematic for patients with chronic viral hepatitis B, since the new liver is reinfected (selected reviews, 219-221). Therefore, liver transplantation should only be considered in a clinical setting wherein prevention of reinfection of the allograft is attempted (222). The use of hepatitis B immunoglobulin in high doses for prolonged periods delays rather than prevents recurrence (219). 

In case of adverse events, the infusion rate should be reduced [39"]. High infusion rates and high doses have been identified as susceptibility factors for thrombotic events in patients at risk [43 ]. In a meta-analysis of five studies in acute thromboc) openic purpura in 334 patients, the overall risk of adverse events was much lower for low-dose than high-dose intravenous immunoglobulin (pooled OR = 0.39 95% Cl = 0.18, 0.83) [61 ]. In subgroup analyses in children only or in adults only, there were no statistical significant differences. 

Mitzel-Kaoukhov H, Staubach P, Muller-Brenne T. Effect of high-dose intravenous immunoglobulin treatment in therapy-resistant chronic spontaneous urticaria. Ann Allergy Asthma Tmmnnol 2010 104(3) 253-8. 

Richter C, Schnabel A, Csemok E, et al. Treatment of anti-neutrophil cytoplasmic antibody (ANCA)-associated systemic vascuhtis with high-dose intravenous immunoglobulin. Chn Exp Immunol 1995 101(l) 2-7. 

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