Intravenous immunoglobulin hypertension

Thrombosis in elderly patients with an increased risk of thrombosis, such as those with hypertension or previous episodes of infarction, has been described (44). A few cases of thrombosis subsequent to intravenous immunoglobulin have been reported, including myocardial infarction in five patients, stroke in four cases, and spinal cord ischemia in one (45). It has been postulated that these events are induced by platelet activation and increased plasma viscosity (12). 

Transient hypertension occurred in a patient with der-matomyositis during therapy with intravenous immunoglobulin (51). In the past, his diastolic blood pressure had been 104-106 mm Hg, but he was normotensive with antihypertensive drug medication. 

It has been recommended that patients with cardiac diseases should be monitored during intravenous immunoglobulin therapy, because hypertension and cardiac failure have occurred, presumably as a result of fluid overload or electrolyte shifts (52). 

Several cases of intravenous immunoglobulin-related thrombosis have been reported (78,79). It can be either venous or arterial (80). It has been suggested that thrombosis can be caused by platelet activation and increased plasma viscosity (79). In patients with vascular risk factors, such as old age, hypertension, and a history of stroke or coronary artery disease, complications, such as myocardial infarction, pulmonary embolism, stroke, and acute spinal cord events, have been described (80). Intravenous immunoglobulin enhances platelet aggregation and the release of adenosine triphosphate in human platelets in vitro. In addition, there is a dose-related increase in plasma viscosity with increasing plasma immunoglobulin concentration (79,80). 

Cardiovascular Blood pressure changes, tachycardia, phlebitis, stroke, myocardial infarction, and collapse have been associated with intravenous immunoglobulin in patients at risk [39 , 40, 43, 45, 52 , 53 . One patient with impairment of preexisting hypertension benefited from increasing the administration period from 2 to 3 days [54. ... 

Cardiovascular Hypotension, hypertension, chest pain, and rarely dysrhythmias or myocardial infarction have been associated with the use of intravenous immunoglobulin [1, 53, 54, 55", 57"]. In a small crossover study in patients with multifocal motor neuropathy there was one case of phlebitis... 

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