Immunoglobulin intramuscular

The development of freeze-drying for the production of blood derivatives was pioneered during World War II (96,97). It is used for the stabilization of coagulation factor (98,99) and intravenous immunoglobulin (IgG iv) products, and also for the removal of ethanol from intramuscular immunoglobulin (IgG im) solutions prior to their final formulation (Fig. 2). 

The resuspended and formulated Fraction II precipitate normally contains some aggregated IgG and trace substances that can cause hypotensive reactions in patients, such as the enzyme prekail ikrein activator (186). These features restrict this type of product to intramuscular adininistration. Further processing is required if products suitable for intravenous adininistration are required. Processes used for this purpose include treatment at pH 4 with the enzyme pepsin [9001-75-6] being added if necessary (131,184), or further purification by ion-exchange chromatography (44). These and other methods have been fiiUy reviewed (45,185,187,188). Intravenous immunoglobulin products are usually suppHed in the freeze-dried state but a product stable in the solution state is also available (189). 

In Vitro and Animal Immunoglobulin Studies. When injected intramuscularly, extracts of cotton are immunogenic in rabbits, and show both true and pseudoimmune precipitating reactions (32, 33). However, in rabbits exposed to cotton dust by inhalation, as in man, no precipitating antibodies are detected (34). 

Miranda-Filho D, Ximese R, Barone A, et al. Randomised controlled trial of tetanus treatment with antitetanus immunoglobulin by the intrathecal or intramuscular route. Br Med ] 2004 328 615-8. 

The usual dose of Rho(D) immune globulin is 2 mL intramuscularly, containing approximately 300 meg anti-Rh0(D) IgG. Adverse reactions are infrequent and consist of local discomfort at the injection site or, rarely, a slight temperature elevation. Hyperimmune Immunoglobulins... 

Abbreviations. Ab, antibody SC, subcutaneous IV, intravenous CHO HSA, human serum albumin SC, subcutaneous USP, United States Pharmacopeia AHF IU, international unit NMT, not more than Ig, immunoglobulin BHK, baby hamster kidney PEG, polyethylene glycol hGH, human growth hoimone IM, intramuscular WFI, water for injection. 

Human tetanus immunoglobulin is a solution of human immunoglobulin G (IgG) containing a high level of anti-tetanus toxin antibodies. It is prepared from the plasma of screened, human donors immunised against tetanus toxin and is administered by intramuscular injection. The product also contains isotonic sodium chloride, glycine, as a stabiliser, sodium acetate and a small amount of sodium hydroxide used to maintain pH. The product is generally well-tolerated. 

These antigens are commonly administered by frequent, intravenous injection without adjuvant. Results are obtained quickly, the antisera often containing a high proportion of IgM immunoglobulin. There is a risk both of direct toxicity early in immunization and of severe hypersensitivity reactions as a result of later injections. With some at least of the antigens in question, equally satisfactory results can be obtained by intramuscular injection of Freund s emulsions—immunization is slower but less risky. 

Adverse effects associated with intramuscular or subcutaneous administration of immunoglobulin are extremely rare, and are usually related to IgA deficiency in the patient or to additives in the preparation (for example preservatives). Adverse effects associated with intravenous immunoglobulin are more frequently seen and may be either local or systemic (138,139). Local reactions are essentially attributable to the technique used and are not specific to the intravenous immunoglobulin. 

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. 

Human rabies immunoglobulin is administered in a dose of 20 lU/kg (0.133 mL/kg). If anatomically feasible, the entire dose should be infiltrated around the wonnd(s). Any remaining volnme should be administered intramuscularly at a site distant from the... 

Hib Hemophilus influenzae type b HSCT hematopoietic stem cell transplant IMIG intramuscular immunoglobulin IPV inactivated polio vaccine ITP immune thrombocytopenic purpura IVIG intravenous immunoglobulin LAIV live attenuated influenza vaccine MMR measles-mumps-rubeUa vaccine OPV oral polio vaccine... 

Rho(D) inunune globulin is indicated whenever fetal red blood cells are known or suspected to have entered the circulation of an Rh-negative mother unless the fetus is known also to be Rh-negative. The drug is given intramuscularly. The half-life of circulating immunoglobulin is approximately 21 to 29 days. 

Figure 2.2 Plasma IgG levels following i.m. or s.c. injection in humans. This graph, which is redrawn from Figure 1 in [2], shows the difference in IgG uptake following oral administration and subcutaneous, intramuscular, or intravenous injection. In this particular situation, anti-Rh immunoglobulin G (IgG) was injected into the deltoid or subcutaneously in the buttock. Uptake rates were higher for i.m. injection (0.43 0.11 day" ) than for s.c. injection (0.22 0.025 day" ). Peak concentrations, which occurred after 3 days, were higher for i.m. injection ( 40%) than s.c. injection ( 30%). Pharmacokinetic analysis was used to predict average concentrations and rates of equilibration between vascular and extravascular compartments.

Prions The use of bovine thrombin in fibrin sealants increases the risk of transmission of bovine spongiform encephalitis (BSE) [11 ]. However, the risk of transmitting prion diseases by giving human blood or blood products is theoretical at present. Because of the long incubation time it is challenging to evaluate the risk [2 ]. In 168 UK cases of variant Creutzfeldt-Jakob disease (vCJD), nine patients had received fractionated plasma products on 12 occasions, intramuscular immunoglobulins for travel on four occasions Rh(D) immunoglobulin for rhesus... 

All healthcare personnel with potential exposure to blood, blood-contaminated body fluids, other body fluids, or sharps should receive a vaccination. Administer the hepatitis B vaccine using the intramuscular route in the deltoid muscle. The OSHA Bloodbome Pathogens standard requires employers to offer the hepatitis B vaccine free of charge to all potentially exposed employees within 10 days of hire. Administer post-exposure prophylaxis with hepatitis B immunoglobulin (passive immunization) and/or vaccine (active immunization) when indicated after per-cutaneous or mucous membrane exposure to blood known or suspected to contain hepatitis B. Needle-stick or other percutaneous exposures of unvaccinated persons should lead to initiation of the hepatitis B vaccine series. HBV vaccination requirements are as follows ... 

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