IMMUNOGLOBULIINIHOITO

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Lähettäjä: Soijuv Lähetetty: 4.2.2005 10:35

Immunoglobuliinihoitoa annetaan nykyään toisinaan myös borrelioosia sairastaville silloin kun henkilön immunoglobuliinien tuotannossa on todettu häiriöitä. Tällaisten henkilöiden immuunijärjestelmä ei toimi kunnolla ja he ovat alituisessa vaarassa sairastua erilaisiin infektiotauteihin. Tällaisissa tilanteissa suonensisäsisesti annettava immunoglobuliinihoito (esim. Venogamma) saattaa olla avuksi. Hoitoa annetaan esim kerran kolmessa viikossa.

Immunoglobuliinin valmistukseen käytetään useiden verenluovuttajien luovuttamaa verta ja siksi sivuvaikutukset ovat mahdollisia. Immunoglobuliinihoidon mahdollisia sivuvaikutuksia ovat mm. päänsärky, pahoinvointi, oksentelu, kuume, vilunväreet, vähentynyt virtsaaminen, ahdistus, verenpaineen lasku, ihottumaa, hengitysvaikeuksia, kutinaa, pistelyä , puutumista jne.

Milloinkahan suomalaiset lääkärit, tutkijat ja potilaat kertoisivat esim. hoitomenetelmistä niin että tieto olisi kaikkien ihmisten saatavissa? Suomessa immunoglobuliinihoitoa annetaan tällä hetkellä borrelioosia sairastaville, vaikka seuraava kertomus sen käytöstä tuleekin jälleen Amerikasta.


Steve's Corner

by

Stephen J. Nostrom RN, Founder/Director

Lyme Borrelia Out-Reach Foundation, Inc.Circa 1987

INTRAVENOUS GAMMA GLOBULIN THERAPIES

Purpose: For the treatment of primary immunodeficiency states in which severe impairment of antibody forming capacity has been shown.

As time passes in this "unfolding drama," called Lyme Borreliosis, some Lyme patients are presently being treated with IgG IV or, Intravenous Gamma Globulin "G" therapies.

Patients with any "chronic" illness often suffer from immunodeficiency. The use of IgG IV is being used more and more in the Lyme community as a result of chronic Lyme Borreliosis.

What is Gamma Globulin G? It is an immunizing agent (passive), a platelet count stimulator, an antibacterial, antiviral, and antipolyneuropathy agent. It comes in many forms, examples are: Gamimune, Gammagard SD, Gammar PIV, Polygam SD, Sandoglobulin etc. It is one of five different classes of humoral antibodies produced by the body. It is a specialized protein synthesized by the body in response to invasions by bacteria, fungi, and viruses. IgG crosses the placenta and protects against red blood cell antigens (the bad germs) and white cell antigens. The normal concentration of IgG in serum is between 800 to 1,600 mg/dl.

Some General Information about Hypogammaglobulinemia

This condition is present in patients who do not make sufficient amounts of antibodies, known as immunoglobulins.

Ex: Suppressed immune system, "chronic disease," and a large number of 'other' disease processes. Such patients are prone to repeated infections and therefore require replacement therapies with immunoglobulin. This is made by extracting the antibody fraction from donations of human blood (the IgG is removed from donor blood from many donors). Preparation of immunoglobulin are now available which can be given intravenously. Such infusions can now be given safely in the patients home.

PATIENT SELECTION

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The patient must be under the care of a physician. The initial infusion is done in a hospital or doctors office, clinic etc.

Why? There is always the potential risk of an adverse reaction when administering any new therapy, to any patient, for the first time...more on this later as to risks!

PRODUCT STORAGE AND HANDLING

READ THE DIRECTIONS.....Some IgG may be left at room temperature, while others need to be refrigerated. Since this is derived or processed from donated human plasma, it requires special handling. Special storage, dilution, and reconstitution instructions are discussed in the package insert. Follow these instructions to the letter and if in doubt, call someone for help. I speak of the nurse or physician here as the "patient" will never be required/responsible in administering this therapy. IgG that has been refrigerated is extremely viscous, that is thick, so it must be brought to room temperature prior to infusion. It should never be heated. Why? Because heating will alter the protein structure.

Simply take it out of the fridge an hour or two prior to infusion. My point here is, don't put it under hot water or "nuke" it, and keep in mind temperature conditions in the home (winter vs summer).

IGIV is supplied in single dose vials, so once it has been opened, it must be used. Check with your doctor/pharmacist with any questions always!

PATIENT ASSESSMENTS

An initial history is made by the physician, nurse and a physical examination is to be completed prior to infusion. The patient's baseline vital signs are recorded-temperature, atypical pulse, respirations, blood pressure, weight, height, lung sounds etc. The type of blood tests prior to therapy will vary from patient to patient. Pre and post infusion with immunoglobulins (IgA, IgG, IgM) are routinely (or should be) included in all labs performed. Once baseline trough and peak immune globulin levels are established, trough measurements alone are recommended to be monitored at three month intervals. Since IgG is obtained from human donors, liver function tests (LDH, SGOT, SGPT, and GGT) are highly recommended every six months to monitor for non-A non-B hepatitis, even though it develops only rarely.

DELIVERY INSTRUCTIONS

Make arrangements prior to any delivery of the medication. Why? As shared earlier, some IgG needs to be refrigerated immediately, while others may be stored at room temperature. My point here is: this is very expensive medicine, about $125 per gram- multiply this by 60 grams and we're talking "big bucks." SOOO, you want to be at home for the delivery and not have it "cooking" on your front stoop in the middle of the summer, or freezing in January.

HYDRATION

As shared in last month's newsletter, make sure you are hydrated. Drink lots of water a couple of days prior to any IV start up. NO CAFFEINE and NO ALCOHOL, as these are diuretics and will cause dehydration. ALL LYME PATIENTS know the dangers of alcohol and caffeine, or should know by now. Don't do it! Hydration is important in the administration of this treatment in other more important ways. IgG can lower ones' blood pressure, so it is VERY

IMPORTANT to be hydrated before any administration.

RECONSTITUTIONS of IGIV

The pharmacy or nurse will worry about this, however it is imperative to make sure all the solute, medication is completely diluted, so inspect it closely. Oftentimes a filter is attached to the primary tubing when called for, but because of the thickness of some IgG products a filter may clog and make it impossible to administer the medication.

The reconstitution will vary from product to product so be well familiar with the procedure for any particular brands.

The amount of dilution will also vary, and NEVER use less than recommended.

VITAL SIGNS

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The nurse or physician will be monitoring your vital signs often. Prior to administration, the first 15 minutes of admin., the second 15 minutes of admin., the half-hour mark and at least, every hour thereafter. If they do not, ask why not!

Tell them "Steve said to," and if they question you, have them call me. In all seriousness, vitals must be taken often as the medication can cause changes such as low blood pressure, fever, rapid heart beat, increased breathing and an apical pulse should be taken (with a scope) and compared with a radial pulse (wrist).

The Rates of Administration

These will vary as to the type of IGG the patient may be receiving. The rates are based upon many factors, such as weight, age, base line health, kidney function and much more. My point here is this: NEVER INFUSE this medication rapidly! Initially, for the first fifteen minutes, the medication may be infused as little as two to four drops (depending upon the gtt or primary drip chamber setting) a minute. Every fifteen minutes it will be increased, then each half-hour, then each hour. If there are changes in vitals, stop or slow down the drip rate and continue monitoring the patient. The patient needs to communicate with the nurse doing the administration as to how they are feeling. Communication is a must!

Pre-Medications

All of my patients are provided pre-medications one half-hour prior to any infusion with IgG. This may vary as to dose and/or medications, for example, weight, allergy etc. For the most part, benadryl as well as Tylenol, are part of the pre-medication treatment plan. Why? So as to offset any possible headache, fever and histamine release during, as well as, after the treatment.

RISKS, Signs and Symptoms of Trouble

As shared earlier, any new medication may have side effects. Keep in mind this also: "Just because you have had the medication before" and this goes with any medication, an allergic reaction may occur during and/or after the administration. With IgG, each lot is "different," that is, it's the same medication, but from different donors. If the IgG is a one shot (day) administration vs two or more days, a week's infusion, etc., that patient has more in his/her system than the patient with one dose. Also, the amount of grams must be considered. My point here is: It will build up over days, and the potential of side effects increase. As to SIDE EFFECTS, in all honesty, I have witnessed few in my patients, who have ranged in age from six to eighty-five. As long as the medication is not rushed, the norm is from four to twelve hours' infusion time, depending upon the age, weight, dose, etc., of the patient. But it can happen and it can happen very quickly. I had one young child go "sour" in a matter of thirty seconds! My point here is communication and compliance.

Remember: Be well hydrated, get a good night's rest, stay properly nourished, and there must be communication between patient and nurse! In the case mentioned above, the child had been my patient for over two years, she handled the infusion well, but in this case, she was dehydrated, had not had proper rest and much more. In a nutshell, she had not been compliant or followed the rules. It is VERY RARE for any negative problems to occur when administrating this medication, provided the guidelines above are followed.

Headache, nausea, vomiting, fever, chills, decreased urine output, shortness of breath, anxiety, decrease in blood pressure or increase in B/P, neck pain, rash, itching, welting, a "sense of impending doom", heightened anxiety, tightness of the skin of the face, flushing, dizziness, disorientation and parathesias (pins and needles) and shortness of breath, are possible side effects to IgG therapy.

An anaphylaxis kit is a must in the home, at bedside, with appropriate medications to be given should there be any problems, as well as the caregiver to be available to dial 911 in an emergency. There must always be an adult in the home, other than the patient, in case a problem should arise.

Usually if there is going to be a problem, a reaction, it will occur in the first fifteen minutes to a half hour of the administration. Until next month, I hope this assists, stay well, contact me direct if you have additional questions, concerns.....God bless, Stephen

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Lähettäjä: jukka61 Lähetetty: 9.2.2005 19:52

Muutama oma kokemus IVIG-hoidosta. Kolme kertaa on nyt takanapäin ja olo on todella kohentunut (ei tarkoita, että ongelmat olisi ohi). 4-vuotta, joista 2-vuotta AB:lla ja Borren lisäksi jatkuvia tulehduksia, jne, nyt näyttäisi, että IVIG-hoito toimii.

Kannattaa pyytää lääkäriä tutkimaan immuunijärjestelmä ja jos on jatkuvia tulehduksia, pitkittyneitä flunssia voi hoito myös auttaa. Elimistöhän taistelee koko ajan Borrea vastaan ja on alttiina muille bakteereille ja viruksille.

Osana hoitoa olen pyrkinyt noudattamaan aika tarkkaa ruokavaliota, ulkoillut, jne. Asiassa on "hassuinta" se, että, kun yleiskunto ja vointi on parantunut, nimenomaan neurologiset oireet, joita harvoin edes tunnistetaan Borren oireiksi, ovat vähentyneet olennaisesti. Kipuihin hoito ei ole vielä vaikuttanut, mutta on tehnyt niiden kanssa elämisen siedettäväksi.

Tämä siis oma maallikon kommentti.