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Guidelines on the use of intravenous immune globulin for hematologic conditions.
Transfus Med Rev. 2007 Apr;21(2 Suppl 1):S9-S56.
Anderson D, Ali K, Blanchette V, Brouwers M, Couban S, Radmoor P, Huebsch L, Hume H, McLeod A, Meyer R, Moltzan C, Nahirniak S, Nantel S, Pineo G, Rock G.
IVIG Hematology and Neurology Expert Panels.
Canada's
per capita use of intravenous immune globulin (IVIG) grew by
approximately 115% between 1998 and 2006, making Canada one of the
world's highest per capita users of IVIG. It is believed that most of
this growth is attributable to off-label usage.
To help ensure IVIG use
is in keeping with an evidence-based approach to the practice of
medicine, the National Advisory Committee on Blood and Blood Products
of Canada (NAC) and Canadian Blood Services convened a panel of
national experts to develop an evidence-based practice guideline on the
use of IVIG for hematologic conditions. The mandate of the expert panel
was to review evidence regarding use of IVIG for 18 hematologic
conditions and formulate recommendations on IVIG use for each. A panel
of 13 clinical experts and 1 expert in practice guideline development
met to review the evidence and reach consensus on the recommendations
for the use of IVIG. The primary sources used by the panel were 3
recent evidence-based reviews. Recommendations were based on
interpretation of the available evidence and where evidence was
lacking, consensus of expert clinical opinion. A draft of the practice
guideline was circulated to hematologists in Canada for feedback. The
results of this process were reviewed by the expert panel, and
modifications to the draft guideline were made where appropriate. This
practice guideline will provide the NAC with a basis for making
recommendations to provincial and territorial health ministries
regarding IVIG use management. Specific recommendations for routine use
of IVIG were made for 7 conditions including acquired red cell aplasia;
acquired hypogammaglobulinemia (secondary to malignancy);
fetal-neonatal alloimmune thrombocytopenia; hemolytic disease of the
newborn; HIV-associated thrombocytopenia; idiopathic thrombocytopenic
purpura; and posttransfusion purpura. Intravenous immune globulin was
not recommended for use, except under certain life-threatening
circumstances, for 8 conditions including acquired hemophilia; acquired
von Willebrand disease; autoimmune hemolytic anemia; autoimmune
neutropenia; hemolytic transfusion reaction; hemolytic transfusion
reaction associated with sickle cell disease; hemolytic uremic
syndrome/thrombotic thrombocytopenic purpura; and viral-associated
hemophagocytic syndrome. Intravenous immune globulin was not
recommended for 2 conditions (aplastic anemia and hematopoietic stem
cell transplantation) and was contraindicated for 1 condition
(heparin-induced thrombocytopenia). For most hematologic conditions
reviewed by the expert panel, routine use of IVIG was not recommended.
Development and dissemination of evidence-based guidelines may help to
facilitate appropriate use of IVIG.
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