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Intravenous Immunoglobulin (IVIG)

Mother comforting son in the hospital

Your child's doctor has prescribed a blood product called Intravenous Immunoglobulin (IVIG) for your child. This page explains what IVIG does and how it is given to your child. It also explains what side effects or problems your child may have when he is given IVIG.

What is IVIG?

IVIG is a blood product. It is made up of immunoglobulins (say: im-YOU-no-GLOB-you-lins), which are also called antibodies. Antibodies help protect the body from germs, such as viruses. Antibodies are made by the immune system. The immune system is the part of the body that helps fight infection.

IVIG is sometimes called Gamma.

What is IVIG used for?

IVIG is given to patients with diseases that affect the immune system. Children who do not have enough antibodies are given IVIG to help boost their immune system.

IVIG is also used to treat diseases that happen when the immune system attacks the person's own body. These are called autoimmune disorders.

IVIG is given to your child through an IV

The word "intravenous" (IV) means we give the IVIG directly into your child's vein. A nurse will put a hollow needle into a vein in your child's hand or arm. Once the nurse has found the vein, the needle will be taken out and what is left in the vein is a very soft flexible tube (like a tiny straw) for the IVIG to flow through. The nurse will then attach a long tube to the tiny tube already in your child's vein. The IVIG will slowly flow into your child's vein through the tube.

Your child may need to stay in the hospital overnight to take the IVIG. Or your child may need to come to the hospital just for the day. This depends on how sick your child is.

It usually takes between 2 and 6 hours to give your child the IVIG. But it may take longer. This depends on your child's weight and the type of IVIG used. You should plan to stay all day at the hospital.

The IVIG may be given all at once, or in separate doses on more than 1 day.

A nurse will check on your child as the IVIG is given

Your child will be given IVIG very slowly at first. The nurse will measure your child's temperature, heart rate, breathing rate, and blood pressure. These are called vital signs. If they stay normal and your child has no side effects or problems, the nurse will gradually increase the flow of IVIG.

As long as the IVIG is going in, the nurse will keep checking your child's vital signs. If your child has any side effects, the nurse will give the IVIG more slowly or stop it. Vital signs will be check every 15 minutes in the beginning until your child is getting the fastest flow of IVIG with no side effects.

Side effects from IVIG are usually mild

In general, IVIG is a safe treatment. Most side effects are mild and easy to control. They do not cause problems that last for a long time. A few patients have more serious side effects, but these are very rare. Because of all the liquid going into your child's body, your child may need to go to the bathroom a lot while she is getting the IVIG.

Talk to your child's doctor about the benefits and risks of IVIG and its possible side effects.

The most common side effects of IVIG

Some children have side effects when they take IVIG. Side effect can happen while the IVIG is going in and up to two days after.

Call your child's nurse or doctor if your child has any of these side effects:

  • headache
  • fast heart rate
  • dizziness or feeling light-headed
  • backache
  • flushing of face
  • nausea or feeling sick to the stomach
  • stomach pain
  • throwing up
  • muscle pain or tenderness
  • tightness in the chest or wheezing
  • rash or hives
  • chills or feeling cold
  • fever

Side effects can often be stopped or reduced

If your child has any side effects, you or your child should tell the nurse. Side effects can often be reduced or stopped if the IVIG is given more slowly. Sometimes other medicines can also help reduce the side effects.

If your child has had problems with IVIG before, the doctor may prescribe medicine for your child before the IVIG is started.

Severe side effects to IVIG are rare

Some children may have a severe side effect called an anaphylactic reaction. This is dangerous, but it is very rare. It usually happens right after starting the IVIG.

If your child has an anaphylactic reaction, he will have some or all of the following signs. Tell your child's nurse right away if you notice your child having any of these signs:

  • trouble breathing and tightness in the chest
  • fever
  • flushing and swelling of the face
  • feeling sick to the stomach
  • dizziness
  • throwing up
  • rash or hives

Rare, severe reactions to IVIG

A very small number of patients have other, more severe reactions to IVIG. Most of these slowly go away after the IVIG is stopped.

The signs of these reactions are described below. If you notice any of these signs in your child after you have gone home, call your child's doctor right away. If the symptoms are severe, bring your child to your local emergency department.

Aseptic meningitis

Aseptic meningitis is a swelling of the outer covering of the brain. "Aseptic" means it is not caused by an infection. Aseptic meningitis usually happens after all the IVIG has gone in and can happen up to 48 hours after your child starts taking it.

These are some signs of aseptic meningitis:

  • fever
  • severe headache
  • neck stiffness
  • feeling sick to the stomach
  • throwing up
  • sensitivity to light

Your child may also be less alert.

Hyperviscosity syndrome

In hyperviscosity syndrome, the blood becomes thick and does not flow through the body as quickly as usual.

These are some signs of hyperviscosity syndrome:

  • headache
  • fatigue or tiredness
  • blurred vision

Kidney failure

In kidney failure, the kidneys stop working properly. Kidney failure is most likely to happen in children who have had kidney problems before.

These are some signs of kidney failure:

  • your child cannot urinate (pee)
  • your child's urine is much darker than usual

Non-infectious hepatitis

Non-infectious hepatitis is an inflammation of the liver.

These are some signs of non-infectious hepatitis:

  • pain on the right side just under the lower ribs
  • feeling sick to the stomach

Very little risk of infection from IVIG

IVIG goes through several steps to make sure it is safe and will not cause infection:

  • All people who give blood are screened to find out if they might have an infection or other disease.
  • All blood is tested for serious infections, such as the AIDS virus and hepatitis.
  • IVIG is treated to kill most viruses and bacteria before it is given to patients.

You cannot donate blood specifically for your child's treatment

IVIG makes up a very small part of your blood. It takes blood from thousands of donors to make enough IVIG to give your child.

IVIG may affect how some vaccines work and when they should be given

If your child needs a vaccine after having IVIG, talk to your child's doctor about the best time to have it. However, this does not apply if your child has an antibody deficiency.

  • If your child needs the measles, mumps, and rubella (MMR) vaccine, you should wait 10 months after IVIG treatment.
  • If your child needs the varicella (chickenpox) vaccine, you should wait 5 months.
  • If your child had either of these vaccines less than 14 days before having IVIG, then the vaccine should be given again after the suggested waiting time.
  • Your child should have all other immunizations as usual.

Jennifer Boyd, RN, MHSc, CNN(C)

Brenda Reid, RN, MN

Heather Dunn, RN

3/17/2008

At SickKids:

Your child will be given the IVIG either while he or she is staying in the hospital overnight or is just at the hospital for the day. If your child is at the hospital just for the day he or she will be given the IVIG at the Medical Short Stay Unit (4C). This will depend on how sick your child is.





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