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Immunoglobulins: Nursing Pharmacology



immune globulin IV (BayGam, Flebogamma, Gammagard), immune globulin SC (BayGam, Cutaquig, Cuvitru, Hizentra), immune globulin IM (BayGam, Gammastan), hepatitis B immune globulin (HBIG), tetanus immunoglobulin (TIG), botulism immune globulin (BIG), Rh(D) immune globulin (RhoGAM, WinRho)
  • Increase antibody levels in individuals with immunodeficiency
  • Help fight off infectious diseases
  • Prevent the immune system from attacking the body’s own healthy cells
  • Replacement therapy for immunodeficiency
  • Prophylaxis of infectious diseases
  • Treatment of inflammatory or autoimmune disorders (e.g., Kawasaki disease, idiopathic thrombocytic purpura, Guillain-Barré syndrome, etc.)
  • Prevention of Rh sensitization in pregnant Rh-negative clients
  • IV, SC, IM
  • Headache
  • Local injection site reactions
  • Flu-like symptoms: fatigue, fever, chills, myalgias, arthralgias, nausea and vomiting
  • Transfusion-associated cardiovascular overload (TACO)
  • Delayed side effects: thrombotic events, skin reactions, renal impairment, hemolysis, neutropenia
  • Rh(D) immune globulin: intravascular hemolysis (boxed warning)
  • IVIG, SCIG, IMIG: thrombosis, renal impairment, acute renal failure (boxed warning)
  • Coagulation disorders
  • Selective IgA deficiency
  • Current symptoms
  • Weight
  • Vital signs, lung sounds
  • Cardiovascular status
  • Hydration status
  • Laboratory test results: CBC, ESR, renal and hepatic function, clotting studies; Coombs test for Rh antibodies
  • Diagnostic test results: echocardiogram

  • Patient IV
  • Epinephrine readily available
  • During administration
    • Hydrate with IV fluids
    • Premedicate with antihistamine and acetaminophen
    • Confirm correct dosage
    • Start infusion at lower rate, then gradually increase

  • Vital signs
  • Intake and output
  • Side effects
    • Local insertion site reactions
    • Notify healthcare provider
      • Hypersensitivity reaction: stop infusion; administer epinephrine if needed
      • Circulatory overload: stop infusion
  • Delayed reactions
  • Therapeutic response: resolution of infection, absence of symptoms
  • Purpose of medication: treat infection and resolve symptoms
  • Administered IV over 2–24 hours
  • Symptoms should resolve three days
    • If not, second dose may be needed
  • Side effects (immediate)
    • Headaches, flu-like symptoms, fluid overload
  • Notify healthcare provider
    • Thrombosis
      • Lower extremity swelling, tenderness; chest pain, shortness of breath; coughing up blood; severe headache
    • Renal damage
      • Decreased urine output, blood in urine, unusual weight gain, severe abdominal pain
    • Hemolysis
      • Fatigue, dark urine, or yellowing of the skin or eyes

Human immunoglobulin therapy contains a mixture of immunoglobulins, also called antibodies, derived from the plasma of healthy donors.

Immunoglobulin therapy is used in a variety of health conditions, including treatment of immune deficiencies, prophylaxis of infectious diseases, and management of various inflammatory or autoimmune diseases, such as Kawasaki disease, idiopathic thrombocytopenic purpura, and Guillain-Barré syndrome.

Immunoglobulin products primarily contain IgG antibodies, as well as small amounts of IgM and IgA antibodies.

There are three routes of immunoglobulin administration: intravenous, more commonly known as IVIG, subcutaneous, or SCIG, and intramuscularly, or IMIG.

Other examples of commonly used immunoglobulins include the hepatitis B immune globulin, or HBIG, which is administered to clients after exposure to the hepatitis B virus; the tetanus immunoglobulin, or TIG, which is used primarily for prophylaxis of tetanus infection in clients with traumatic, puncture, or contaminated wounds; and the botulism immune globulin, or BIG, which is used to treat infant botulism caused by toxin type A or B.

Additionally, a specific immunoglobulin called RhO (D) immune globulin, or RhoGAM, is given to Rh-negative clients during pregnancy in order to prevent Rh immunization against their Rh-positive fetus.

Once administered, immunoglobulins act just like natural antibodies; so they recognize a specific antigen, bind to it so that the immune system can eliminate it, as well as modulating the immune response.

This can be helpful to fight off infections, as well as to prevent the immune system from attacking the body’s own cells in autoimmune disorders.

One thing to keep in mind is that immunoglobulins offer passive immunity, which is temporary and only lasts for as long as the antibodies persist, usually a few weeks to months.

Now, the most common side effects of immunoglobulin therapy are headaches and local injection site reactions.

Other common side effects include flu-like symptoms, such as fatigue, fever, chills, myalgias, and arthralgias, as well as nausea and vomiting.

For the most part, these side effects can be minimized by slowing down the rate of infusion or by taking anti-inflammatory medications, like NSAIDs.

Additional severe side effects include transfusion-associated circulatory overload, or TACO, which happens when a large volume of fluid is transfused in a short amount of time.

This can cause circulatory overload and pulmonary edema, especially in clients with underlying cardiovascular or renal disease.

Finally, immunoglobulin therapy can cause delayed side effects that will appear in the following days or weeks of administration.

These can include thrombotic events, skin adverse reactions, renal impairment, neutropenia, and hemolysis.

In fact, IVIG, SCIG, and IMIG have boxed warnings for thrombosis, as well as for renal impairment and even acute renal failure; while RhO (D) immune globulin has a boxed warning for intravascular hemolysis.

Regarding contraindications, immunoglobulins are not recommended in clients with selective IgA deficiency, as IGIV products can contain small amounts of IgA antibodies that could be recognized as foreign and trigger a severe anaphylactic reaction.

Additionally, immunoglobulins should be used cautiously in clients with a known history of previous exposure to immunoglobulins, since the risk of hypersensitivity reactions increases with each use.

Precautions should also be taken with clients who have coagulation disorders or thrombocytopenia.

Finally, RhO (D) immune globulin is contraindicated in Rh-positive clients, because it can cause a hemolytic reaction.

Now, when caring for a pediatric client with Kawasaki disease who is prescribed an immunoglobulin like IVIG, first, perform a baseline assessment by asking the child’s parents or caregivers about current symptoms, including irritability, and lethargy; also, be sure to assess the child for peeling skin on the hands and feet, as well as the presence of a strawberry colored tongue.

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