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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.

BackgroundABN immunoglobulin (Ig) guidelines advise routine FBC and U and E monitoring with every treatment episode and screening for IgA deficiency. AimsWe audited compliance in inflammatory neuropathy patients on longterm treatment in two UK Neurology departments. We looked for evidence of clinically relevant haematological or AKI Ig-related events.MethodsData was collected from Nov 2015 to Nov 2017. Accepted definitions for clinically and/or biochemically significant haemolysis, neutropenia, thrombocytopenia and AKI were used.Results1919 treatment episodes in 90 patients were analysed. Mean age (SD)=57.6 (14.4)years, 69.1% male, 74% CIDP (26% MMN), 94% IVIg (6% SCIg). Mean dose=1.57 (0.74) g/kg/month or 97.1 (37.3) g/infusion. No clinically significant episodes of haemolysis, neutropenia, thrombocytopenia or AKI occurred in relation to Ig treatment. An asymptomatic drop of >10 g/L Hb occurred in 68/1919 episodes in 38 individuals (3.5%); mean reduction 17.7 g/L, lowest Hb 99 g/L. Two patients with CRF (stage 3) received 28 (IV) and 104 (SC) infusions respectively without impact on eGFR. Two individuals with relative IgA deficiency (0.38 g/L, 0.4 g/L) received 16 infusions over 1.5 years without complications.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 longterm IVIg use.

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