Flu-like syndrome: flushing, headache, chills, low-grade fever, nausea, malaise, mild hypotension, muscle aches during infusion | 1–15 |
Fast infusion rate IgA proportion First infusion of IVIg
|
Fc receptor–mediated release of prostaglandins, platelet-activating factor and cytokines from leukocytes Aggregation of IgG, leading to complement activation Formation of immune complex
|
Slow infusion rate Discontinuation of infusion Product brand substitution Premedication with one or more of antipyretic, corticosteroid or antihistamine Subcutaneous infusion
| Mild and transient |
Intravascular acute hemolysis during infusion and lasting up to 3 d after infusion | < 0.1 |
|
|
Blood type cross-matching Determination of anti-A and anti-B antibody titer before infusion Post-transfusion testing for hemolysis within 36 h in patients with anemia
| Moderate (should not require transfusion) |
Acute aseptic meningitis within 48–72 h after infusion | < 0.1 |
Fast infusion rate History of migraine
|
|
| Moderate and transient |
Arterial or venous thromboembolic event (transient ischemic attack, stroke or peripheral deep thromboembolism) starting within 24 h after infusion | < 0.1 |
First infusion of IVIg Age > 60 yr High dose Previous thrombotic event and thrombophilia Risk factors for cardiovascular events (e.g., dyslipidemia, hypertension, diabetes) Autoimmune disease or cancer
|
Rheological properties of IVIg leading to hyperviscosity Contamination with clotting factors Vasospasm secondary to release of vasoactive molecules Formation of platelet–leukocyte aggregates
|
| Moderate to severe |
Hypertension and fluid overload during infusion and lasting up to 2 d after infusion | < 1 |
Previous elevated plasma viscosity (e.g., polycythemia, paraproteinemia) Previous heart and kidney failure
|
|
| Moderate to severe |
Acute renal failure (from transient mild alteration in renal function to renal failure requiring dialysis) starting within 1–10 d after infusion | < 1 |
Age > 60 yr Obesity and type 1 diabetes Pre-existing renal disease Sepsis Paraproteinemia Use of nephrotoxic agents
|
Direct toxicity on proximal renal tubular epithelial cells, osmotic tubular injury secondary to stabilizers used in IVIg preparation (sucrose, maltose, glucose) Cryoglobulin precipitate
|
Adequate hydration Monitoring of renal function before and after infusion Use of sugar-free stabilizers Avoidance of concomitant nephrotoxic therapy Avoidance in cryoglobulinic-positive patients
| Mild to severe |
Non–IgE-mediated anaphylactic reaction (from tightness of throat or chest, chills and rigor to breathlessness, dizziness, fainting or collapse and death) starting early during infusion | < 0.1 |
|
|
Discontinuation of infusion and supportive treatment (intensive care unit) Screening of IgA deficiency in patients before infusion Use of IVIg preparation with lower concentration of IgA
| Moderate to severe |
Local reaction to subcutaneous immunoglobulin (swelling, redness, itching or burning sensation) | 8–50 |
|
|
| Mild to moderate |