WED 241 Clinical relevance of regular blood monitoring in IG treatment

Abstract

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.

Dramatic clinical response to ultra-high dose IVIg in otherwise treatment resistant inflammatory neuropathies

“…There is conflicting evidence about whether the risk of developing these side effects correlates with dose of IVIg. Rajabally et al reported that a daily dose greater than 35g of IVIg resulted in a higher risk of thrombotic events and another large retrospective, UK study found clinically significant Ig-related haemolysis occurred in association with induction bolus doses only (34,35). The same study revealed Ig-related biochemical changes in haemoglobin and sodium without clinical effect occurred more commonly in individual with low pre-treatment haemoglobin or those on concomitant medication which can contribute to hyponatraemia (35).…”

“…Rajabally et al reported that a daily dose greater than 35g of IVIg resulted in a higher risk of thrombotic events and another large retrospective, UK study found clinically significant Ig-related haemolysis occurred in association with induction bolus doses only (34,35). The same study revealed Ig-related biochemical changes in haemoglobin and sodium without clinical effect occurred more commonly in individual with low pre-treatment haemoglobin or those on concomitant medication which can contribute to hyponatraemia (35). A study in our neuromuscular cohort did not find a difference in IVIg doses between the group of patients experiencing a thromboembolic event and those who did not (34,36).…”