Abstract
Background and objective: Intravenous immunoglobulin (IVIg) is a solution of globulins containing antibodies derived from pooled human plasma of donors and used in the treatment of a number of immune deficiencies and autoimmune diseases. However, several investigators have reported biochemical alterations with use of IVIg. The objective of this study was to evaluate the effects of IVIg therapy on selected biochemical and hematologic parameters in patients with autoimmune mucocutaneous blistering diseases (AMBDs).
Methods: In this preliminary clinical study, ten patients with AMBDs (seven with pemphigus vulgaris and three with mucous membrane pemphigoid) received 133 cycles of IVIg for a total of 399 infusions. We evaluated the effects of IVIg therapy on serum hemoglobin (Hb), albumin, and electrolyte levels, including sodium (Na+), potassium (K+), chloride (Cl-) and calcium (Ca2+). Values of these parameters were measured 24 hours before, during, and 24 hours and 4 weeks after the 3-day infusion period.
Results: The observed variations in serum electrolyte levels were physiologically and clinically negligible. Furthermore, 24 hours after the last infusion, mean electrolyte values had spontaneously returned to normal levels without the need for additional supplementation: Na+ 137.59 ± 1.42 mmol/L (p = 0.6091 vs baseline); K+ 3.97 ± 0.5 mmol/L (p = 0.2689); Cl- 103.4 ± 2.69 mmol/L (p = 0.0388); and Ca2+ 9.07 ± 0.44 mg/dL (p = 0.5332). Conversely, significant variations in mean Hb and albumin levels were observed. When measured 24 hours after the last infusion, mild/moderate decreases in Hb (11.62 ± 2.12 g/dL; p = 0.009 vs baseline) and/or albumin (mean 3.14 ± 0.24 g/dL; p = 0.0016 vs baseline) were evident. Such changes may, albeit very rarely, be of sufficient clinical significance in individual patients as to necessitate additional treatment.
Conclusion: In patients receiving intravenous IVIg for AMBDs, electrolyte values should be monitored but do not represent a real clinical threat. Hemoglobin and albumin values may be altered sufficiently to require additional treatment but this is a very rare occurrence. These findings confirm and extend previous reports of the safety of IVIg therapy.
Similar content being viewed by others
Notes
The use of trade names is for product identification purposes only and does not imply endorsement.
References
Ballow M. Clinical and investigational considerations for the use of IGIV therapy. Am J Health Syst Pharm 2005; 62 (16 Suppl. 3): S12–8; quiz S19-21
Ahmed AR. Use of intravenous immunoglobulin therapy in autoimmune blistering diseases.Int Immunopharmacol 2006; 6: 557–78
Ahmed AR, Dahl MV, for the Consensus Development Group. Consensus statement on the use of intravenous immunoglobulin therapy in the treatment of autoimmune mucocutaneous blistering diseases. Arch Dermatol 2003; 139: 1051–9
Rutter A, Luger TA. Intravenous immunoglobulin: an emerging treatment for immune-mediated skin diseases. Curr Opin Investig Drugs 2002; 3: 713–9
Jolles S. A review of high-dose intravenous immunoglobulin (hdIVIg) in the treatment of the autoimmune blistering disorders. Clin Exp Dermatol 2001; 26: 127–31
Harman KE, Black MM. High-dose intravenous immune globulin for the treatment of autoimmune blistering diseases: an evaluation of its use in 14 cases. Br J Dermatol 1999; 140: 865–74
Ahmed AR. Intravenous immunoglobulin therapy for patients with pemphigus vulgaris unresponsive to conventional immunosuppressive treatment. J Am Acad Dermatol 2001; 45: 679–90
Baum S, Scope A, Barzilai A,. The role of IVIg treatment in severe pemphigus vulgaris. J Eur Acad Dermatol Venereol 2006; 20: 548–52
Bystryn JC, Jiao D, Natow S. Treatment of pemphigus with intravenous immunoglobulin. J Am Acad Dermatol 2002; 47: 358–63
Ahmed AR, Sami N. Intravenous immunoglobulin therapy for patients with pemphigus foliaceus unresponsive to conventional therapy. J Am Acad Dermatol 2002; 46: 42–9
Sami N, Bhol KC, Razzaque Ahmed A. Intravenous immunoglobulin therapy in patients with multiple mucosal involvement in mucous membrane pemphigoid. Clin Immunol 2002; 102: 59–67
Ahmed AR. Intravenous immunoglobulin therapy for patients with bullous pemphigoid unresponsive to conventional immunosuppressive treatment. J Am Acad Dermatol 2001; 45: 825–35
Gourgiotou K, Exadaktylou D, Aroni K,. Epidermolysis bullosa acquisita: treatment with intravenous immunoglobulins. J Eur Acad Dermatol Venereol 2002; 16: 77–80
Ahmed AR. Treatment of autoimmune mucocutaneous blistering diseases with intravenous immunoglobulin therapy. Expert Opin Investig Drugs 2004; 13: 1019–32
Weinberg MA, Insler MS, Campen RB. Mucocutaneous features of autoimmune blistering diseases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997; 84: 517–34
Hertl M, Eming R, Veldman C. T cell control in autoimmune bullous skin disorder. J Clin Invest 2006; 116: 1159–66
Yancey KB. The pathophysiology of autoimmune blistering diseases. J Clin Invest 2005; 115: 825–8
Sitaru C, Zillikens D. Mechanism of blister induction by autoantibodies. Exp Dermatol 2005; 14: 861–75
Chan LS, Ahmed AR, Anhalt GJ, et al. The first international consensus on mucous membrane pemphigoid: definition, diagnostic criteria, pathogenic factors, medical treatment and prognostic indicators. Arch Dermatol 2002; 138: 370–9
Yu Z, Lennon VA. Mechanism of intravenous immune globulin therapy in antibody-mediated autoimmune diseases. N Engl J Med 1999; 340: 227–8
Jolles S, Sewell WAC, Misbah SA. Clinical uses of intravenous immunoglobulin. Clin Exp Immunol 2005; 142: 1–11
Li N, Zhao M, Hilario-Vargas J, et al. Complete FcRn dependence for intravenous Ig therapy in autoimmune skin blistering diseases. J Clin Invest 2005; 115: 3440–50
Akilesh S, Petkova S, Sproule TJ, et al. The MHC class I-like Fc receptor promotes humorally mediated autoimmune disease. J Clin Invest 2004; 113: 1328–33
Mimouni D, Blank M, Ashkenazi L,. Protective effect of intravenous immunoglobulin (IVIG) in an experimental model of pemphigus vulgaris. Clin Exp Immunol 2005; 142: 426–32
Arredondo J, Chernyavsky AI, Karaouni A,. Novel mechanisms of target cell death and survival and of therapeutic action of IVIg in pemphigus. Am J Pathol 2005; 167: 1531–44
Bystryn JC, Jiao D. IVIg selectively and rapidly decreases circulating pathogenic autoantibodies in pemphigus vulgaris. Autoimmunity 2006; 39: 601–7
Bystryn JC, Rudolph JL. IVIg treatment of pemphigus: how it works and how to use it. J Clin Invest 2005; 125: 1093–6
Boros P, Gondolesi G, Bromberg JS. High dose intravenous immunoglobulin treatment: mechanisms of action. Liver Transpl 2005; 11: 1469–80
Berlana D, Vidaller A, Jodar R,. Changes in biochemical, hematological and immunological profiles after low-dose intravenous immunoglobulin administration in patients with hypogammaglobulinemia. Trans Clin Biol 2005; 12: 433–40
Knezevic-Maramica I, Kruskall MS. Intravenous immune globulins: an update for clinicians. Transfusion 2003; 43: 1460–80
Orbach H, Katz U, Sherer Y,. Intravenous immunoglobulin: adverse effects and safe administration. Clin Rev Allergy Immunol 2005; 29: 173–84
Lee KY, Han JW, Lee JS,.Alteration of biochemical profiles after high-dose intravenous immunoglobulin administration in Kawasaki disease. Acta Paediatr 2002; 91: 164–7
Ng SK. Intravenous immunoglobulin infusion causing pseudohyponatremia. Lupus 1999; 8: 488–90
Nguyen MK, Rastogi A, Kurtz I.True hyponatremia secondary to intravenous immunoglobulin. Clin Exp Nephrol 2006; 10: 124–6
Steinberger BA, Ford SM, Coleman TA. Intravenous immunoglobulin therapy results in post-infusional hyperproteinemia, increased serum viscosity, and pseudohyponatremia. Am J Hematol 2003; 73: 97–100
Kessary-Shoham H, Levy Y, Shoenfeld Y,. In vivo administration of intravenous immunoglobulin (IVIg) can lead to enhanced erythrocyte sequestration. J Autoimm 1999; 13: 129–35
Shoham-Kessary H, Naot Y, Gershon H. Immune complex-like moieties in immunoglobulin for intravenous use (IVIg) bind complement and enhance phagocytosis of human erythrocytes. Clin Exp Immunol 1998; 113: 77–84
Katz U, Shoenfeld Y. Review: intravenous immunoglobulin therapy and thromboembolic complications. Lupus 2005; 14: 802–8
Paran D, Herishanu Y, Elkayam O,. Venous and arterial thrombosis following administration of intravenous immunoglobulins. Blood Coagul Fibrinolysis 2005; 16: 313–8
Gelfand EW. Differences between IGIV products: impact on clinical outcome. Int Immunopharmacol 2006; 6: 592–9
Mckay LI, Cidlowsky JA. Corticosteroids. In: Holland JF, Frei E III, editors. Cancer medicine. 5th ed. London: BC Decker, 2000: 730–43
Gaffney K, Scott DG. Azathioprine and cyclophosphamide in the treatment of rheumatoid arthritis. Br J Rheumatol 1998; 37: 824–36
Oren RM. Hyponatremia in congestive heart failure. Am J Cardiol 2005; 95 Suppl.: 2–7B
Anderson CL, Chaudhury C, Kim J,. Perspective: FcRn transports albumin. Relevance to immunology and medicine. Trends Immunol 2006; 27: 343–8
Chaudhury C, Mehnaz S, Robinson JM,. The major histocompatibility complex-related Fc receptor for IgG (FcRn) binds albumin and prolongs its lifespan. J Exp Med 2003; 197: 315–22
Israel EJ, Wilsker DF, Hayes KC,. Increased clearance of IgG in mice that lack beta 2-microglobulin: possible protective role of FcRn. Immunology 1996; 89: 573–8
Katz U, Achiron A, Sherer Y,. Safety of intravenous immunoglobulin (IVIG) therapy. Autoimmun Rev 2007; 6: 257–9
Mahieu AC, Sisti AM, Joekes S,. Pharmacovigilance study of a regional intravenous immunoglobulin (II): evaluation and comparison of an improved pharmaceutical form. Allergol Immunopathol (Madr) 2006; 34: 242–7
Katz U, Kishner I, Magalashvili D,. Long term safety of IVIg therapy in multiple sclerosis: 10 years experience. Autoimmunity 2006; 39: 513–7
Acknowledgments
No sources of funding were used to assist in the preparation of this study. The authors have no conflicts of interest that are directly relevant to the content of this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mignogna, M.D., Fortuna, G., Ruoppo, E. et al. Variations in Serum Hemoglobin, Albumin, and Electrolytes in Patients Receiving Intravenous Immunoglobulin Therapy. AM J Clin Dermatol 8, 291–299 (2007). https://doi.org/10.2165/00128071-200708050-00004
Published:
Issue Date:
DOI: https://doi.org/10.2165/00128071-200708050-00004