Safety of intravenous immunoglobulin and plasma exchange in critically ill patients

Sarah L. Clark, Alejandro Rabinstein

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Objective: To assess the safety profile of intravenous immunoglobulin (IVIG) and plasma exchange (PLEX) when used to treat critically ill patients. Methods: We performed a retrospective analysis of consecutive patients who received IVIG or PLEX while admitted to our medical intensive care unit (ICU), neuroscience ICU or haematologic/oncologic ICU between 2007 and 2011.Patients who were transferred into an ICU while receiving therapy or who continued therapy after discharge from the ICU were included in the analysis. Results: A total of 118 consecutive patients were included in the study. Fifty-nine patients received IVIG. Twenty of these patients (34%) developed renal failure during the hospitalisation, including 15 (25.4%) in whom renal function worsened during or shortly after IVIG administration and 4 (6.8%) in whom IVIG was considered a possible cause. Transfusion reactions occurred in five patients (8%). Seven patients (12%) did not receive the full intended course of IVIG. Thirty-four patients (58%) who received IVIG died during their hospitalisation. Fifty-nine patients received PLEX. Hypotension requiring an intervention was noted with 39 sessions (8.5%) and led to discontinuation of the session in 11 (2.4%). Other adverse events included line-related infections (n=4), pneumothorax (n=4) and electrolyte abnormalities and transfusion reactions (n=10). Six patients (10%) did not receive full intended treatment course of PLEX. Nineteen patients (32%) treated with PLEX died during their hospitalisation. Discussion: Intravenous immunoglobulin and PLEX are generally well tolerated by critically ill patients. Intravenous immunoglobulin was associated with worsening renal function in one-quarter of patients.

Original languageEnglish (US)
Pages (from-to)593-598
Number of pages6
JournalNeurological Research
Volume37
Issue number7
DOIs
StatePublished - Jan 1 2015

Keywords

  • Adverse events
  • Critical care
  • Intensive care unit
  • Intravenous immunoglobulin
  • Plasma exchange
  • Safety

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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