Intravenous immunoglobulin infection risk

Prophylactic intravenous administration of standard immune globulin as compared with cote-lipopolysaccharide immune globulin in patients at high risk of postsurgical infection. The Intravenous Immunoglobulin Collaborative Study Group. N Engl J Med 327 (1992) 234-240. 

Fatal hepatic veno-occlusive disease, characterized by hyperbilirubinemia, hepatomegaly, ascites, and weight gain, has been associated with intravenous immunoglobulin administered prophylactically to prevent trans-plant-related infections (79). To avoid such thrombotic complications, intravenous immunoglobulin should be infused at a slower rate in patients at risk, and high dosages (400-1000 mg/kg) should not be infused. 

Despite cases of transmission of hepatitis C associated with intravenous immunoglobulin in the 1990s, no cases of transmission of hepatitis, HIV, or Creutzfeldt-Jakob disease have since been reported with immunoglobulins [6 J. Before 1996, PCCs (prothrombin complex concentrates) were associated with minimal risk of transmission of infective agents [7 ]. There are no documented cases of viral transmission in patients with von Willebrand disease or hemophilia A treated with Haemate P/Humate P in over 25 years of clinical experience in Europe and more than 17 years in the USA [ ]. In the IMPACT-1 and IMPACT-2 trial in 124 patients there were no cases of HIV, hepatitis, or human B19 virus conversion. Furthermore, no cases of viral transmission have been reported during 30 years of post-marketing surveillance of Cl-esterase inhibitor concentrate [9, 10 ]. 

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