BackgroundPre-treatment screening for IgA deficiency and close monitoring of full blood count (FBC) and urea and electrolytes (U&E) is recommended with intravenous immunoglobulin (IVIg) therapy in neurological diseases. AimsTo examine the frequency of biochemically defined and clinically significant episodes of treatment associated haemolysis, neutropenia, thrombocytopenia and acute renal impairment in a cohort of patients on maintenance Immunoglobulin (Ig) therapy for inflammatory neuropathy. MethodsA retrospective review of routine blood monitoring in a cohort of patients from two UK specialist peripheral nerve centres. Accepted definitions for clinically and biochemically significant haemolysis, neutropenia, thrombocytopenia and acute kidney injury (AKI) were used.Results 1919 infusion episodes in 90 patients were analysed. Age (mean(S.D))= 58.09(14.4)years, 63% male, 72% CIDP (28% MMN), 97% IVIg (3% SCIg). Dose= 1.57 (0.79) g/kg/month or 97.1(37.3)g/infusion, frequency: 3.9 (1.4) weeks.Relative IgA deficiency was noted in 2 individuals (prevalence: 2.2%, 95% C.I.: 0-5.2) who received a combined total of 38 infusions (3800g IVIg) without adverse event. No clinically significant episodes of haemolysis, neutropenia, thrombocytopenia or AKI occurred in relation to treatment. An asymptomatic drop>10g/L haemoglobin (Hb) occurred in 3.5% (95% CI: 2.7-4.3) of treatment episodes in 38 individuals, mean reduction: 17.7(7.4)g/L; lowest Hb: 86g/L. Lower pre-treatment haemoglobin correlated with risk of recurrent episodes Ig-related drop (p:0.007). Two patients with chronic renal failure (stage 1 and 3) had received 28 (IV) and 104 (SC) infusions respectively, (6416g Ig) without impact on estimated glomerular filtration rate (eGFR). ConclusionsNo clinically significant Ig-related events were identified in this representative cohort. We suggest annual screening or clinically indicated testing as safe and more appropriate in long-term Ig use. Screening for IgA deficiency and baseline FBC and U&E may be helpful in identifying those at greater risk of complication.

The presence of free malignant cells in the peritoneal cavity of patients with colon cancer provided no further prognostic information relative to the Dukes classification in this study. Nevertheless, further study is needed, particularly in a larger series of Dukes B patients, for whom a new prognostic factor would be useful for deciding adjuvant therapy.