Immunoglobulins: Nursing pharmacology

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.

Next, assess the child’s weight, vital signs, lung sounds, and cardiovascular status, as well as their hydration status.

Then, review their recent laboratory test results, including CBC, ESR, renal and hepatic function, clotting studies including PT and INR, as well as Coombs test for Rh antibodies.

Lastly, review recent diagnostic tests, like echocardiogram. Next, explain to your client’s parents or caregivers that the medication will help to treat the infection and resolve their current symptoms.

Also, let them know that the medication will be administered intravenously over 2 to 24 hours, and explain that the child’s symptoms should resolve within 3 days after the infusion; if symptoms don’t resolve, a second dose may be needed.

Then, review with them some common side effects, such as headaches and other flu-like symptoms. Lastly, reassure them that you will be monitoring for these side effects, and that they can be managed by slowing down the infusion rate, as well as administering medications like an NSAID.Alright, when preparing to administer IVIG, be sure your client has a patent IV in place and is adequately hydrated with the ordered intravenous fluids.

Prior to starting the infusion, premedicate your client with the ordered antihistamine and acetaminophen. Then, confirm the correct dose by calculating units per kilogram of body weight, and input the correct mL/hr to be administered by infusion pump.

Also, make sure that epinephrine is readily available before starting the infusion, and be prepared to start the infusion at a lower rate, then gradually increase the rate based on your client’s tolerance and reaction to the medication.

While infusing the medication, monitor vital signs, fluid intake and output, and the insertion site for a local reaction; as well as for signs of a hypersensitivity reaction, which can include hypotension, tachycardia, difficulty swallowing or breathing, or an unusual rash.

If this occurs, stop the infusion immediately, notify the healthcare provider, and be prepared to administer epinephrine.

Also, be sure to watch closely for signs of circulatory overload, which can present as shortness of breath, wheezing, orthopnea, as well as tachycardia, hypertension, and a widening pulse pressure; if any of these symptoms occur, notify the healthcare provider immediately.

After the infusion is complete, teach your client and caregivers about side effects that can occur, even days after treatment.

Emphasize the importance of immediately seeking medical attention if they notice signs and symptoms that may indicate delayed side effects; these include symptoms of a blood clot, such as swelling, tenderness, or warmth in the lower extremities, as well as chest pain, shortness of breath, coughing up blood, or a severe headache; as well as symptoms of hemolysis, that could manifest as fatigue, dark urine, or yellowing of the skin or eyes; and symptoms of kidney problems, which can include a decrease in their urine output, blood in the urine, severe abdominal pain, or unusual weight gain.

Lastly, remind them that their child should avoid live vaccines like MMR and varicella.Finally, while caring for a pediatric client receiving IVIG therapy, closely monitor your client’s CBC, fluid status, vital signs, and for the development of side effects that can occur during and after the infusion.

Be sure to evaluate for the desired therapeutic effects of the medication, including the resolution of their symptoms. Alright, as a quick recap… Human immunoglobulin therapy contains a mixture of immunoglobulins derived from the plasma of healthy donors, and can be used for treatment of immune deficiencies, inflammatory or autoimmune diseases, and for prophylaxis of certain infectious diseases.

Immunoglobulins act by recognizing a specific antigen and binding to it so that the immune system can eliminate it, as well as modulating the immune response.

Potential side effects can include injection site reactions, flu-like symptoms, and more severe side effects, such as transfusion-associated circulatory overload, kidney damage, hemolysis and thromboembolic events.

Nursing considerations when administering immunoglobulins include performing a baseline assessment, monitoring for side effects, evaluating for the therapeutic response; as well as providing education about what to expect during treatment, learning to recognize side effects, and when to notify the healthcare provider.

hemolysis and thromboembolic events nursing considerations, when administering immunoglobulins include performing a baseline assessment affects evaluating for the therapeutic response as well as providing education about what to expect during treatment learning to recognize side effects.

And when to notify the healthcare provider,