imunoglobulin intravena
TRANSCRIPT
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Intravenous immunoglobulin therapy
background
Intravenous immune globulin (IVIG) is made of antibodies that have been extracted from blood
donations from 3,000-10,000 healthy donors IVIG is used to treat many autoimmune disorders,idio!athic diseases (disease of un"no#n cause), and infections
Immunoglobulins (Ig) are glyco!rotein molecules that function as antibodies $uring an immune
res!onse, these antibodies, #hich are !resent in the bloodstream, detect and bind to antigens(foreign substances that are ca!able of inducing immune res!onses) %xam!les of antigens
include bacteria, viruses, mold s!ores, dust mites, animal dander, and fungi &nce the antibodies
attach to the antigen, #hite blood cells are stimulated to destroy the antigen 'ince antibodies are
!resent in the bloodstream, they are considered !art of the humoral immune systemImmune globulin !roducts from human !lasma #ere first used in 1* to treat immunoglobulin
deficiencies (li"e IgG deficiency) Initially, treatment #as administered intramuscularly (in+ected
into the muscle) Intravenous (in+ected into the vein) immune globulin #as sho#n to be effectivein autoimmune idio!athic thrombocyto!enic !ur!ura (I) in 1.1 his method is generally
!referred over intramuscular in+ections because it has sho#n to be more effective
/y !roviding antibodies to !atients #ho have #ea"ened immune systems, IGIV can hel! reduce
the ris" of infection reatment may hel! !revent !atients #ith a#asa"i disease fromdevelo!ing coronary artery aneurysms (#ea"ened of the main artery in the heart) IGIV may also
hel! increase the number of !latelets in !atients #ho have idio!athic thrombocyto!enia !ur!ura(I)
he ' 2ood and $rug dministration (2$) has a!!roved immunoglobulin !roducts for the
treatment of !rimary immunodeficiencies, immune-mediated thrombocyto!enia, a#asa"i
disease, hemato!oietic stem cell trans!lantation (in !atients older than *0 years), chronic /-celllym!hocytic leu"emia, and 4IV in children
Immune globulin !roducts contain sterile, !urified immunoglobulin G (IgG) he !roducts
ty!ically contain more than 5 unmodified IgG and only trace amounts of immunoglobulin (Ig) or immunoglobulin 6 (Ig6) IgG antibodies are the smallest, but most abundant
antibodies in the body, ma"ing u! 7-.05 of all the antibodies in the body hey are !resent inall body fluids he IgG antibodies are considered the most im!ortant antibodies for fightingagainst bacterial and viral infections, and they are the only antibodies that can cross the !lacenta
during !regnancy Ig antibodies are !rimarily found in the nose, air#ay !assages, digestive
tract, ears, eyes, saliva, tears and vagina hese antibodies !rotect body surfaces that are
fre8uently ex!osed to foreign organisms and substances from outside of the body Ig6antibodies !resent in the blood and lym!h fluids, and they are the first antibodies that are
!roduced in res!onse to an infection
'ide effects from IVIG occur in less than five !ercent of !atients, according to researchers9ommon side effects ty!ically occur immediately after infusions and may include flushing
(reddening of the chee"s), headache, chills, di::iness, increased s#eating, leg cram!s, !ain and
tenderness at the in+ection site, tiredness, muscle !ain, lo#er bac" !ain, nausea, and lo# blood!ressure
'ince IVIG is !ooled from thousands of blood donors, it is theoretically !ossible that viruses or
bacteria could be transmitted in the !roduct 4o#ever, since 1., all !roducts are tested for4IV and he!atitis and the ris" of contracting the virus is extremely lo#
synonyms
llergic, allergic reaction, allergic res!onse, antibody, antibodies, antigen, autoimmune disease,autoimmune disorder, autoimmunity, blood donor, chronic /-cell lym!hocytic leu"emia,
cyto!enias, glyco!rotein, hemato!oietic stem cell trans!lantation, human !lasma, humoral
immune system, idio!athic thrombocyto!enia, immune, immune defense system, immuneglobulin, immune-mediated thrombocyto!enia, immune res!onse, immune system, Ig, Ig, Ig$,
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Ig%, IgG, Ig6, immunodeficiencies, immunoglobulin, immunoglobulin isoty!es,
immunoglobulin , immunoglobulin $, immunoglobulin %, immunoglobulin G,
immunoglobulin 6, immunomodulation, immunomodulating agents, intravenous, intravenousimmunoglobulin, isoty!es, a#asa"i disease, leu"ocytes, !lasma, !rimary immunodeficiencies,
serum, #ea"ened immune system, #hite blood cells
uses
General; Immune globulin !roducts have been used to treat many autoimmune disorders,
idio!athic (un"no#n cause) diseases, and infections he beneficial effects of IVIG for the!revention infections in !atients #ith !rimary immunodeficiency syndromes (disorders caused
by intrinsic or genetic defects in the immune system) are #ell established IVIG has also sho#n
to !revent severe lo#er res!iratory tract infections, but not u!!er res!iratory tract and non-res!iratory infections in !atients #ith common variable immune deficiency (9VI$)
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treatment, #hich may be life threatening herefore, these !atients should receive the first
infusion in the hos!ital under medical su!ervision
Immune globulin !roducts also contain small amounts of cyto"ines, 9$A cells, 9$. cells, andhuman leu"ocyte antigens (4@) 9yto"ines are !roduced by immune cells to stimulate the
immune res!onse 9$A cells detect antigens in the body 9$. cells detect and destroy body cells
that are infected #ith a bacteria, virus or fungi 4@ molecules hel! the bodyBs immune systemdistinguish bet#een self and non-self (foreign or invading) substances
IVIG is available in different concentration (strengths) he ' 2ood and $rug dministration
(2$) has a!!roved Gammagard '>$C, Gammar- IVC, Gamimune-DC, IveegamC,olygamC '>$, 'andoglobulinC Venoglobulin-IC, Venoglobulin-'C, 9arimune>anglobulinC,
GamunexC, and /axter GC
monitoring ivig use
atients receiving intravenous immune globulin (IVIG) thera!y should be closely monitored
$uring a !hysical examination, healthcare !roviders should obtain a com!lete medical history,
including #hether a !atient has ever had liver or "idney disease or reactions to blood !roducts ortransfusions
idney function tests should be !erformed because there have been re!orts of "idney failure
associated #ith IVIG com!lete blood count (9/9) should be conducted because !atients #ho receive IVIG have a
ris" of develo!ing hy!er!roteinemia (high levels of !rotein in the blood), increased serum
viscosity and !seudohy!onatremia (lo# levels of sodium in the blood), thrombosis (blood clotsdee! in the legs), transient serum sic"ness, transient neutro!enia, or severe cutaneous vasculitis
atients should be tested for he!atitis because there have been re!orts of he!atitis transmission
through IVIGImmunoglobulin levels should be tested to ma"e sure the !atient does not have Ig deficiency
Individuals #ho are Ig deficient should not receive IVIG because they may ex!erience a severeallergic reaction called ana!hylaxis
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the $-sorbitol-stabili:ed formulation atients #ho ex!erience decreased urination, sudden
#eight gain, s#elling of the legs or an"les, or shortness of breath should consult their healthcare
!roviders immediately because these may be signs of "idney failure atients should tell theirhealthcare !roviders if they have "idney diseases because they may have an increased ris" of
develo!ing "idney failure
!iver disease; 4e!atitis 9 has been transmitted to !atients via IVIG"kin infection; @ife-threatening human !arvovirus /1 infections have been transmitted via
IVIG
Other; &ther side effects may include !ost-infusion hy!er!roteinemia (high levels of !rotein inthe blood), increased serum viscosity and !seudohy!onatremia (lo# levels of sodium in the
blood), thrombosis (blood clots dee! in the legs), transient serum sic"ness, transient neutro!enia,
severe cutaneous vasculitis, dermatitis (such as ec:ema), and hair loss
precautions
atients should tell their healthcare !roviders if they are ta"ing any drugs (!rescri!tion or over-
the-counter), herbs, or su!!lements because they may interact #ith treatment'ince intravenous immune globulin (IVIG) may cause "idney failure, it is es!ecially im!ortant
for !atients to tell their healthcare !roviders if they are F years old or older or if they have ever
had "idney disease, diabetes, se!sis, !lasma cell disease ,or volume de!letion atients shouldalso tell their doctors if they are ta"ing ami"acin (mi"inC), gentamicin (EenamicinC),
stre!tomycin, or other drugs that can cause "idney damage atients #ho ex!erience decreased
urination, s#elling of the legs or an"les, sudden #eight gain, or shortness of breath shouldconsult their healthcare !roviders immediately because these are common sym!toms of "idney
failure
atients should tell their healthcare !roviders if they are allergic to any drugsatients #ho are !regnant, !lan to become !regnant, or are breastfeeding should consult their
healthcare !roviders before undergoing IVIG thera!yatients should tell their healthcare !roviders if they have had received any live vaccines
(vaccines that contain live viruses), such as measles, mum!s, and rubella (66
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#erapi imunoglobulin intravena
latar belakang
Immune globulin intravenous (IVIG) terbuat dari antibodi yang telah diambil dari donor darah
dari donor yang sehat 3,000-10,000 IVIG diguna"an untu" mengobati berbagai gangguanautoimun, !enya"it idio!ati" (!enya"it tida" di"etahui !enyebabnya), dan infe"si
Imunoglobulin (Ig) yang gli"o!rotein mole"ul yang berfungsi sebagai antibodi 'elama res!on
imun, antibodi ini, yang hadir dalam aliran darah, mendete"si dan mengi"at antigen (:at asingyang mam!u merangsang res!on imun) 9ontoh antigen termasu" ba"teri, virus, s!ora +amur,
tungau debu, bulu binatang, dan +amur 'etelah antibodi mele"at !ada antigen, sel darah !utih
dirangsang untu" menghancur"an antigen arena antibodi yang hadir dalam aliran darah,
mere"a diangga! sebagai bagian dari sistem imun humoralrodu" immune globulin dari !lasma manusia !ertama "ali diguna"an !ada tahun 1* untu"
mengobati "e"urangan imunoglobulin (IgG se!erti defisiensi) #alnya, !engobatan diberi"an
secara intramus"ular (disunti""an "e dalam otot) Intravena (disunti""an "e !embuluh darah)immune globulin terbu"ti efe"tif dalam autoimun idio!ati" thrombocyto!enic !ur!ura (I)
!ada tahun 1.1 6etode ini lebih di!ilih dari!ada sunti"an intramus"ular "arena telah terbu"ti
lebih efe"tif
$engan memberi"an antibodi terhada! !asien yang sistem "e"ebalannya melemah, IGIV da!atmembantu mengurangi risi"o infe"si engobatan da!at membantu mencegah !asien dengan
!enya"it a#asa"i dari mengembang"an aneurisma arteri "oroner (melemah dari arteri utama di+antung) IGIV +uga da!at membantu mening"at"an +umlah trombosit !ada !asien yang memili"i
idio!ati" trombosito!enia !ur!ura (I)
' 2ood and $rug dministration (2$) telah menyetu+ui !rodu" immunoglobulin untu"
!engobatan imunodefisiensi !rimer, trombosito!enia imun-dimediasi, !enya"it a#asa"i,trans!lantasi sel indu" hemato!oieti" (!ada !asien yang lebih tua dari *0 tahun), leu"emia
limfositi" sel-/ "ronis, dan 4IV !ada ana"-ana"
rodu" immune globulin mengandung steril, dimurni"an imunoglobulin G (IgG) rodu"biasanya mengandung lebih dari 5 dimodifi"asi IgG dan hanya melaca" +umlah
immunoglobulin (Ig) atau immunoglobulin 6 (Ig6) ntibodi IgG yang ter"ecil, ta!i !alingbanya" antibodi dalam tubuh, membuat 7-.05 dari semua antibodi dalam tubuh 6ere"a hadirdi semua cairan tubuh ntibodi IgG diangga! sebagai antibodi yang !aling !enting untu"
mela#an infe"si ba"teri dan virus, dan mere"a adalah satu-satunya antibodi yang da!at mele#ati
!lasenta selama "ehamilan ntibodi Ig terutama ditemu"an di hidung, bagian saluran na!as,
saluran !encernaan, telinga, mata, air liur, air mata dan vagina ntibodi ini melindungi!ermu"aan tubuh yang sering ter"ena organisme asing dan :at dari luar tubuh ntibodi Ig6
hadir dalam darah dan cairan getah bening, dan mere"a adalah antibodi !ertama yang di!rodu"si
sebagai res!on terhada! infe"si%fe" sam!ing dari IVIG ter+adi dalam #a"tu "urang dari lima !ersen !asien, menurut !ara
!eneliti %fe" sam!ing yang umum biasanya ter+adi segera setelah infus dan mung"in termasu"
!embilasan ("emerahan !i!i), sa"it "e!ala, menggigil, !using, mening"at ber"eringat, "ram "a"i,rasa sa"it dan nyeri di tem!at sunti"an, "elelahan, nyeri otot, nyeri !unggung ba#ah, mual, dan
te"anan darah rendah
arena IVIG yang di"um!ul"an dari ribuan !endonor darah, secara teori bah#a virus atauba"teri da!at ditular"an dalam !rodu" Damun, se+a" tahun 1., semua !rodu" yang diu+i untu"
4IV dan he!atitis dan risi"o tertular virus sangat rendah
sinonim
lergi, rea"si alergi, rea"si alergi, antibodi, antibodi, antigen, !enya"it autoimun, gangguan
autoimun, autoimunitas, donor darah, leu"emia limfositi" "ronis sel-/, cyto!enias, gli"o!rotein,
trans!lantasi sel indu" hemato!oieti", !lasma manusia, sistem "e"ebalan humoral,trombosito!enia idio!ati" , "e"ebalan tubuh, sistem !ertahanan "e"ebalan tubuh, immune
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globulin, trombosito!enia imun-dimediasi, res!on imun, sistem "e"ebalan tubuh, Ig, Ig, Ig$,
Ig%, IgG, Ig6, imunodefisiensi, immunoglobulin, isoty!es imunoglobulin, imunoglobulin ,
immunoglobulin $, imunoglobulin %, immunoglobulin G, imunoglobulin 6,immunomodulation, agen imunomodulasi, intravena, imunoglobulin intravena, isoty!es,
!enya"it a#asa"i, leu"osit, !lasma, immunodeficiencies !rimer, serum, melemah"an sistem
"e"ebalan tubuh, sel-sel darah !utih
menggunakan
$mum%!rodu" globulin imun telah diguna"an untu" mengobati berbagai gangguan autoimun,idio!ati" (tida" di"etahui !enyebabnya) !enya"it, dan infe"si %fe" menguntung"an dari IVIG
untu" infe"si !encegahan !ada !asien dengan sindrom imunodefisiensi !rimer (gangguan yang
disebab"an oleh intrinsi" atau geneti" cacat dalam sistem "e"ebalan tubuh) yang ma!an IVIG+uga telah ditun+u""an untu" mencegah infe"si saluran !erna!asan ba#ah yang !arah, teta!i
tida" atas saluran !erna!asan dan infe"si non-saluran !ernafasan !ada !asien dengan defisiensi
imun umum variabel (9VI$) ara !eneliti menemu"an bah#a !asien 9VI$ dengan infe"si
tersebut meres!on lebih bai" terhada! o!erasi dan obat-obatanIVIG biasanya diberi"an secara intravena selama se"itar dua sam!ai em!at +am sehari selama
dua sam!ai tu+uh hari asien biasanya menerima dosis tunggal lain setia! 10-*1 hari atau setia!
tiga sam!ai em!at minggu, tergantung !ada +enis dan ting"at "e!arahan "ondisi asien biasanyamulai menangga!i !engobatan setelah se"itar dela!an hari engobatan terus-menerus membantu
!asien mem!ertahan"an ting"at sehat antibodi dalam darah, yang mening"at"an sistem
"e"ebalan tubuh mere"a
&enggunakan disetu'ui FDA%he ' 2ood and $rug dministration (2$) telah menyetu+ui
IVIG untu" !engobatan imunodefisiensi !rimer, trombosito!enia imun-dimediasi, !enya"it
a#asa"i, trans!lantasi sel indu" hemato!oieti" (!ada !asien yang lebih tua dari *0 tahun),limfositi" "ronis sel-/ leu"emia, dan +enis infe"si 4IV I !ediatri" asien yang memili"i
"elainan ini mengalami !enurunan "adar antibodiegunaan lain%IVIG telah diguna"an untu" mengobati berbagai "ondisi lain, termasu" anemia
a!lasti", murni a!lasia sel darah merah, anemia berlian-/lac"fan, anemia hemoliti" autoimun(menyerang sistem "e"ebalan tubuh sel darah merah), !enya"it hemoliti" (!enghancuran sel
darah merah) dari baru lahir, fa"tor !enghambat di!eroleh VIII, menga"uisisi !enya"it von
=illebrand, neutro!enia "e"ebalan-dimediasi (rendahnya ting"at neutrofil, ya"ni sel-sel darah!utih), refractoriness transfusi !latelet, neonatal aloimun > autoimun trombosito!enia, !asca-
transfusi !ur!ura, trombosito!enia !ur!ura tromboti" > hemoliti" sindrom uremi", e!ile!si
(gangguan "e+ang), !ediatri" "eras sindrom Guillain-/arr?, demielinasi !olineuro!ati "ronisinflamasi, myasthenia gravis, @ambert-%aton sindrom miastenia, multifo"al neuro!ati motori",
multi!le sclerosis (!enya"it degeneratif ota" dan sumsum tulang bela"ang), rheumatoid arthritis (
de#asa dan rema+a), lu!us eritematosus sistemi" (gangguan autoimun yang menyebab"an!eradangan "ronis), vas"ulitis sistemi", dermatomiositis, !olymyositis, myositis in"lusi tubuh,=egener granulomatosis, adrenoleu"odystro!hy, amyotro!hic lateral sclerosis, melemah otot
+antung, sindrom "elelahan "ronis, blo" +antung "ongenital, cystic fibrosis (me#arisi !enya"it
yang menyebab"an tubuh mem!rodu"si terlalu banya" lendir), dermatosis teri" autoimun,diabetes mellitus, dysautonomia idio!ati" a"ut, ence!halomyelitis disebarluas"an a"ut,
endoto"semia, rea"si transfusi hemoliti", sindrom hemo!hagocytic, leu"emia limfoblasti" a"ut,
sindrom rendah motor neuron, multi!le myeloma (+enis "an"er), sel- manusia lym!hotro!hicmielo!ati virus-1-ter"ait, sindrom nefriti", nefro!ati membranosa, o!hthalmo!athy eutiroid,
o!soclonus-mio"lonus, infe"si telinga berulang, degenerasi serebral !araneo!lastic, neuro!ati
!ara!roteinemic (fungsi abnormal saraf), !arvovirus infe"si (umum), &%6' (!olineuro!ati,
organomegali, endocrino!athy, 6-!rotein, dan !erubahan "ulit) sindrom, !rogresif lumbosa"ral!lexo!athy, radiculoneuritis lyme, sindrom
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yang menderita, infe"si virus atau ba"teri berulang !arah saluran !erna!asan atau telah terisolasi
defisiensi Ig (dan IgG* tambahan dan "e"urangan IgGA) da!at mengembang"an rea"si
anafila"sis !arah setelah !engobatan IVIG, yang mung"in mengancam nya#a &leh "arena itu,!asien ini harus menerima infus !ertama di rumah sa"it di ba#ah !enga#asan medis
rodu" immune globulin +uga mengandung se+umlah "ecil sito"in, sel 9$A, sel 9$., dan
antigen leu"osit manusia (4@) 'ito"in yang di!rodu"si oleh sel-sel "e"ebalan tubuh untu"merangsang res!on imun 'el 9$A mendete"si antigen dalam tubuh 'el 9$. mendete"si dan
menghancur"an sel-sel tubuh yang terinfe"si dengan ba"teri, virus atau +amur 6ole"ul 4@
membantu sistem "e"ebalan tubuh membeda"an antara diri dan non-diri (asing atau menyerang):at
IVIG tersedia dalam "onsentrasi yang berbeda ("e"uatan) ' 2ood and $rug dministration
(2$) telah menyetu+ui Gammagard ' > $ C, Gammar- IV C, Gamimune-D C, Iveegam C,
olygam C ' > $, 'andoglobulin C Venoglobulin-I C, Venoglobulin-' C, 9arimune >anglobulin C, Gamunex C, dan /axter G C
memantau penggunaan I(IG
asien yang menerima tera!i immune globulin intravenous (IVIG) harus dimonitor secara
se"sama 'elama !emeri"saan fisi", !enyedia layanan "esehatan harus mem!eroleh ri#ayat
medis leng"a!, termasu" a!a"ah !asien !ernah memili"i !enya"it hati atau gin+al atau rea"siterhada! !rodu" darah atau transfusi
es fungsi gin+al harus dila"u"an "arena ada la!oran dari gagal gin+al ter"ait dengan IVIG
4itung darah leng"a! (9/9) harus dila"u"an "arena !asien yang menerima IVIG memili"irisi"o mengembang"an hy!er!roteinemia (tingginya "adar !rotein dalam darah), !ening"atan
vis"ositas serum dan !seudohy!onatremia (rendahnya ting"at sodium dalam darah), trombosis
(gum!alan darah +auh di "a"i), sementara !enya"it serum, neutro!enia transien, atau vas"ulitis"ulit yang !arah
asien harus diu+i untu" he!atitis "arena ada la!oran !enularan he!atitis melalui IVIGadar imunoglobulin harus diu+i untu" memasti"an !asien tida" memili"i "e"urangan Ig
Individu yang "e"urangan Ig seharusnya tida" menerima IVIG "arena mere"a mung"inmengalami rea"si alergi yang !arah disebut anafila"sis
atau
hidro"ortison intravena untu" mencegah rea"si
Anafilaksis%IVIG da!at menyebab"an rea"si anafila"sis yang serius !ada !asien yang memili"iimmunoglobulin (Ig) "e"urangan 4al ini ter+adi !ada se"itar satu dari 00 sam!ai 1000
!asien nafila"sis adalah ce!at, rea"si alergi yang mem!engaruhi seluruh tubuh nafila"sisbiasanya ter+adi segera setelah !era#atan dan berhubungan dengan sensitisasi terhada! Ig !ada!asien dengan defisiensi Ig Ge+ala anafila"sis da!at bervariasi dari ringan sam!ai !arah dan
da!at ber!otensi mengancam nya#a Ge+ala yang !aling berbahaya adalah te"anan darah rendah,
"esulitan berna!as, syo", dan "ehilangan "esadaran, yang semuanya bisa bera"ibat fatal6engguna"an globulin imun Ig-habis da!at membantu mencegah rea"si ini ter+adi ehadiran
IgG antibodi anti-Ig tida" selalu di"ait"an dengan efe" sam!ing !arah IVIG
Aseptic meningitis%da la!oran lang"a meningitis ase!ti" setelah infus IVIG asien harus
memberitahu !enyedia layanan "esehatan mere"a +i"a mere"a mengalami demam, leher "a"u,sa"it "e!ala, "ebingungan, mual, atau muntah
ardiovaskular%da la!oran lang"a serangan +antung setelah IVIG 'ebuah efe" sam!ing yang
umum dari IVIG adalah te"anan darah rendah
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Gagal gin'al%da la!oran dari gagal gin+al setelah IVIG infus, mes"i!un hal ini +arang ter+adi
$ari bulan Euni 1. sam!ai bulan Dovember 1., ' 2ood and $rug dministration (2$)
menerima .. la!oran "erusa"an gin+al ter"ait dengan IVIG di meri"a 'eri"at Gagal gin+al a"utyang ter"ait dengan tera!i IVIG ter+adi dengan formulasi su"rosa-stabil, ta!i tida" dengan-
sorbitol-$ formulasi stabil asien yang mengalami !enurunan buang air "ecil, tiba-tiba "enai"an
berat badan, !embeng"a"an "a"i atau !ergelangan "a"i, atau sesa" na!as harus ber"onsultasidengan !enyedia layanan "esehatan mere"a segera "arena ini mung"in tanda-tanda dari gagal
gin+al asien harus memberitahu !enyedia layanan "esehatan mere"a +i"a mere"a memili"i
!enya"it gin+al "arena mere"a mung"in memili"i !ening"atan risi"o mengembang"an gagalgin+al
)enyakit hati%4e!atitis 9 telah di"irim "e !asien melalui IVIG
Infeksi kulit%infe"si arvovirus /1 mengancam +i#a manusia telah di"irim melalui IVIG
!ain-lain%%fe" sam!ing lain mung"in termasu" !asca-infus hy!er!roteinemia (tingginya "adar!rotein dalam darah), !ening"atan vis"ositas serum dan !seudohy!onatremia (rendahnya ting"at
sodium dalam darah), trombosis (gum!alan darah +auh di dalam "a"i), !enya"it serum transien,
neutro!enia transien, vas"ulitis "ulit yang !arah, dermatitis (se!erti e"sim), dan rambut ronto"
tindakan pencegahan
asien harus memberitahu !enyedia layanan "esehatan mere"a +i"a mere"a mengonsumsi obat(rese! atau over-the-counter), herbal, atau su!lemen "arena mere"a da!at berintera"si dengan
!engobatan
'e+a" immune globulin intravenous (IVIG) da!at menyebab"an gagal gin+al, hal ini terutama!enting bagi !asien untu" memberitahu !enyedia layanan "esehatan mere"a +i"a mere"a berusia
F tahun atau lebih atau +i"a mere"a !ernah memili"i !enya"it gin+al, diabetes, se!sis, !enya"it
sel !lasma, atau volume de!lesi asien +uga harus memberitahu do"ter mere"a +i"a mere"amengambil ami"asin (mi"in C), gentamisin (Eenamicin C), stre!tomisin, atau obat lain yang
da!at menyebab"an "erusa"an gin+al asien yang mengalami !enurunan buang air "ecil,!embeng"a"an "a"i atau !ergelangan "a"i, berat badan tiba-tiba, atau sesa" na!as harus
ber"onsultasi dengan !enyedia layanan "esehatan mere"a dengan segera "arena ini adalah ge+alaumum dari gagal gin+al
asien harus memberitahu !enyedia layanan "esehatan mere"a +i"a mere"a alergi terhada! obat-
obatanasien yang sedang hamil, berencana untu" hamil, atau sedang menyusui harus ber"onsultasi
dengan !enyedia layanan "esehatan mere"a sebelum men+alani tera!i IVIG
asien harus memberitahu !enyedia layanan "esehatan mere"a +i"a mere"a telah menerimava"sin hidu! (va"sin yang mengandung virus hidu!), se!erti cam!a", gondo", dan rubella
(66
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)*+GA+#A,
Imunoglobulin intravena (IVIG) meru!a"an !rodu" darah yang dibuat dari serum antara 1000
dan 1 000 donor !er batch Ini adalah !engobatan !ilihan untu" !asien dengan defisiensiantibodi ntu" indi"asi ini, IVIG diguna"an !ada B!engganti dosisB dari *00-A00 mg > "g berat
badan, diberi"an se"itar 3 mingguan 'ebali"nya, Bdosis tinggiB IVIG (hdIVIG), diberi"an !alingsering !ada * g > "g > bulan, diguna"an sebagai agen Bimunomodulator dalam !ening"atan +umlah
gangguan "e"ebalan dan inflamasi enggunaan a#al hdIVIG adalah untu" thrombocyto!enic
!ur!ura imun (I) !ada ana"-ana" 1H
'!esialisasi "linis mengguna"an +umlah terbesar dari IVIG adalah neurologi, hematologi,
imunologi, nefrologi, ra dan dermatologi IVIG memili"i dam!a" besar !ada !engobatan
gangguan neurologis termasu" dermatomiositis, sindrom Guillain-/arre, demielinasi
!olineuro!ati "ronis inflamasi (9I$), neuro!ati motori" multifo"al (66D), myasthenia gravis
dan sindrom orang "a"u $alam hematologi diguna"an untu" mengobati cyto!enias "e"ebalantubuh, !arvovirus /1 a!lasia ter"ait sel darah merah, hi!ogamaglobulinemia se"under myeloma
dan leu"emia limfati" "ronis dan trans!lantasi sumsum !asca-tulang $alam imunologi IVIGdiguna"an dalam !engobatan defisiensi antibodi !rimer ($), dalam nefrologi, ra dan
oftalmologi telah diguna"an untu" mengobati vas"ulitis, lu!us erythematosis sistemi" ('@%),
!emfigoid sela!ut lendir dan uveitis dan dalam dermatologi diguna"an !aling sering untu"mengobati sindrom a#asa"i, dermatomiositis, ne"rolisis e!idermal to"si" dan !enya"it teri" (
abel 1)
abel 1
egunaan utama dari imunoglobulin intravena I(IG./
$alam tulisan ini, "ami menin+au !er"embangan tera"hir dalam !emahaman tentang me"anisme
a"si IVIG, bidang "linis saat utama !enggunaan ber"onsentrasi !ada "ondisi dengan dasar bu"ti
yang lebih bai" didiri"an dan mendis"usi"an daerah muncul dari !enggunaan IVIG
Go to;
&*A+I"&* *,0A I(IG
6e"anisme a"si dari immunoglobulin tera!i yang "om!le"s, teta!i dalam bebera!a tahun
tera"hir "ema+uan !enting dalam !emahaman telah dibuat (diring"as dalamGambar 1) *Hme"anisme dominan bero!erasi di situasi tertentu tam!a"nya tergantung !ada "edua dosis
immunoglobulin dan !atogenesis !enya"it dalam !ertimbangan
Gambar1inda"an imunomodulator imunoglobulin intravena Imunoglobulin intravena (IVIG), mung"in
untu" tu+uan !emahaman, diangga! sebagai em!at "om!onen yang ter!isah; (1) tinda"an
dimediasi oleh daerah variabel 2 (ab B) *,(*) tinda"an 2c ///
*fek karena F ab 1. 2
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sinergis dengan de"sametason dalam mene"an a"tivasi limfosit yang diu"ur dengan !ergeseran
"urva dosis-res!ons de"sametason dengan 1 log-"ali li!at, ini di"ait"an dengan signifi"an
mening"at"an rese!tor glu"o"orti"oid mengi"at afinitas 33H
e+enuhan neonatal 29< (2c l)setelah /6 $o"ter ana" telah mengguna"an IVIG !ada 0, g > "g dalam dosis tunggal !ada
hari !ertama "ehidu!an !ada ana" dengan !enya"it hemoliti" !ada bayi baru lahir A3H 4al ini
efe"tif dalam mengurangi hemolisis dan "arenanya mengurangi "ebutuhan untu" transfusi tu"ar
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8/12/2019 Imunoglobulin Intravena
18/23
&rang de#asa dengan defisiensi antibodi se"under ('$) yang berhubungan dengan leu"emia
limfositi" "ronis dan myeloma memili"i "eduanya telah terbu"ti manfaat dari tera!i !enggantian
IVIG, +i"a tida" mam!u mounting res!on yang memadai untu" imunisasi diagnosti" denganantigen !olisa"arida (neumovax II) AA,AH 6es"i!un "eman+uran "linis !enggantian IVIG
di '$ diterima, efe"tivitas biaya telah di!ertanya"an AFH rofila"sis antibioti" terus menerus
dengan "otrimo"sa:ol sa+a telah terbu"ti efe"tif dalam myeloma a#al, mes"i!un dengan"e+adian yang signifi"an dari efe" sam!ing A7H, sehingga mendorong !anggilan untu" u+i aca"
membanding"an !rofila"sis antibioti" sendirian dengan IVIG dalam "elom!o" !enya"it ini
$am!a" dari imunisasi dengan !neumococcal con+ugate va"sin baru (revenar) terhada!"e+adian !enya"it !neumo"o"us !ada !asien dengan 9@@ dan myeloma belum dinilai
Go to;
I(IG )ADA )*+5AI# +*$,O!OGI" A$#OI&$+
"indrom Guillain-6arre
'ebuah badan cu"u! bu"ti diring"as dalam 9ochrane revie# sistematis A.H telah menun+u""an
bah#a IVIG sama ber"hasiat untu" !ertu"aran !lasma dalam !engobatan !asien dengan a"ut!araliti" Guillain-/arre syndrome (G/') !a"ah IVIG efe"tif !ada orang de#asa dengan
!enya"it ringan atau !ada mere"a yang memulai !engobatan lebih dari * minggu setelah
timbulnya ge+ala tida" !asti ida" ada bu"ti bah#a menggabung"an IVIG dengan sebelumnya
!ertu"aran !lasma adalah manfaat tambahan 'ama, menggabung"an steroid !ulsa dengan IVIGtida" mena#ar"an manfaat tambahan AH 6es"i!un tida" ada !ercobaan aca" dari IVIG di
masa "ecil G/' bu"ti dari !ercobaan de#asa telah cu"u! !ersuasif untu" IVIG untu"
dire"omendasi"an untu" ana"-ana" dengan G/'
&ultifokal neuropati motorik dengan blok konduksi
6ultifo"al neuro!ati motori" (66D) menya+i"an dengan asimetris "elemahan otot distal yang
mung"in "eliru untu" !enya"it motor neuron teta!i dibeda"an electro!hysiologically oleh"ehadiran lo"al blo" "ondu"si motori" IVIG adalah !engobatan !ilihan di 66D steroid
memili"i !engaruh yang "ecil dan mung"in mem!erburu" !enya"it /ebera!a !ercobaan
ter"ontrol secara aca" 0, 1H telah menun+u""an bah#a IVIG mening"at"an "e"uatan otot,s"or cacat neurologis dan da!at membali""an blo" "ondu"si IVIG tera!i !emeliharaan +ang"a
!an+ang yang bermanfaat !ada banya" !asien 1H
ronis inflamasi demielinasi neuropati CID).
Ini adalah neuro!ati simetris !rogresif yang ditandai secara "linis oleh !ro"simal dan distal
"elemahan, "ehilangan sensori dan areflexia IVIG sema"in mengganti"an steroid (gabungandalam bebera!a "asus dengan !ertu"aran !lasma), sam!ai se"arang !engobatan tradisional untu"
9I$ /u"ti dari !ercobaan ter"ontrol aca" *, 3H menun+u""an bah#a IVIG adalah
"eberhasilan sama dengan steroid dan !ertu"aran !lasma, setida"nya dalam +ang"a !ende"
'ema"in, IVIG lebih disu"ai sebagai tera!i lini !ertama untu" 9I$ mengingat morbiditaster"ait dengan tera!i steroid +ang"a !an+ang 6emang, !asien dengan 66D dan mere"a dengan
motori" 9I$ murni mung"in memburu" setelah steroid !a"ah !engobatan di"ombinasi"an
dengan IVIG dan steroid mena#ar"an manfaat tambahan tida" di"etahui
Dermatomyositis dan miopati inflamasi lainnya
he mio!ati inflamasi !ro"simal yang meru!a"an "ara"teristi" dari dermatomiositis ($6)
adalah immuno!athogenetically di"ait"an dengan microangio!athy tergantung !eleng"a! dalamotot yang ter"ena 6anfaat IVIG !ada !asien dengan $6 refra"ter terhada! tera!i imunosu!resif
standar ditun+u""an dalam !ercobaan !lasebo-ter"ontrol secara aca" !ada tahun 13 AH
!a"ah IVIG lebih unggul steroid sebagai tera!i lini !ertama untu" $6 tida" di"etahui
$alam !olymyositis tahan a!i, IVIG telah terbu"ti berguna dalam u+i terbu"a teta!i belummengalami u+i coba secara aca" /u"ti dari !ercobaan aca" tida" mendu"ung !enggunaan IVIG
dalam in"lusi tubuh myositis
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8/12/2019 Imunoglobulin Intravena
19/23
Cacat dari sambungan neuromuskuler
6yasthenia gravis (6G), gangguan neurologis autoimun ti!i"al ditandai dengan flu"tuasi,
"elemahan otot fatiguable disebab"an oleh antibodi terhada! rese!tor asetil"olin 'atu-satunya
"g
ertanyaan tentang dosis o!timal IVIG ditu+u"an oleh "gmenghasil"an !engurangan besar dalam infe"si dan !ening"atan inde"s s!irometri dibanding"an
dengan !asien yang menerima 0 P * g > "g enelitian selan+utnya dirancang F- F7H untu"
men+a#ab !ertanyaan a!a"ah lebih banya" immunoglobulin yang selalu lebih bai" telah
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8/12/2019 Imunoglobulin Intravena
20/23
menghasil"an hasil yang beragam yang mung"in disebab"an oleh !erbedaan dalam desain
!enelitian, dosis dan "urangnya !eriode #ashout antara lengan dosis yang berbeda dari
!enelitian da !enerimaan luas Damun, di antara immunologists "linis yang !alung ting"at IgGharus di!ertahan"an dalam usia coco" "isaran referensi normal untu" !asien dengan $
dengan !asien individu manfaat dari ting"at enda!an yang lebih tinggi /ebera!a !enelitian F.
- 70H do"umen !enurunan "e+adian !neumonia !ada $ se"ali IVIG ini dimulai mes"i!untemuan !er"embangan asimtomati" bron"ie"tasis 71H !ada bebera!a !asien dengan
imunodefisiensi umum variabel (9VI) mes"i!un menca!ai ting"at IgG melalui lebih dari g > l
meng"ha#atir"an dan menun+u""an bah#a fa"tor-fa"tor lain selain infe"si da!at mengemudi"erusa"an !aru di 9VI
Go to;
I(IG "*6AGAI ),OFI!A"I" #*,4ADA) "*)"I"
)ADA !A4I, ,*+DA4 6*,A# 6ADA+ A#A$ 6A5I
),*&A#$,
6engingat bah#a transfer maternal IgG !ada +anin ter+adi terutama setelah 3* minggu "ehamilan
ada banya" "e!entingan dalam !eran IVIG sebagai !rofila"sis terhada! infe"si !ada bayi!rematur 6es"i!un studi a#al menun+u""an bebera!a manfaat, meta-analisis 9ochrane dari 1
studi 7*H termasu" se"itar 000 bayi !rematur telah menun+u""an bah#a IVIG membuat
!engurangan mar+inal dengan fre"uensi se!sis namun yang !enting tida" mengurangi morbiditaster"ait atau mortalitas secara "eseluruhan 6eta-analisis menyim!ul"an bah#a tida" ada
!embenaran untu" !ercobaan aca" lan+ut dari IVIG !ada bayi !rematur atau bayi berat lahir
rendah
'ama, !eran IVIG sebagai tera!i tambahan untu" dicurigai atau terbu"ti se!sis neonatal tida"didu"ung oleh baru-baru ini 9ochrane meta-analisis 73H yang menun+u""an bah#a
!engurangan "ematian dengan IVIG hanya signifi"ansi marginal
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D*,&A#O!OGI"
ondisi dengan +umlah terbesar dari bu"ti yang di!ubli"asi"an adalah !enya"it a#asa"i, tera!idermatomiositis tahan (lihat bagian neurologi), ne"rolisis e!idermal to"si" dan !enya"it teri"
(!emfigus vulgaris, !emfigoid bulosa, e!idermolisis bulosa ac8uisita, !emfigoid sela!ut lendir,!enya"it Ig linear dan !emfigoid "ehamilan ) di !emfigus vulgaris tertentu ondisi lain dimana bu"ti sebagian besar terdiri dari serang"aian "asus atau la!oran adalah dermatitis ato!i"
7AH, urti"aria "ronis "e"ebalan 7- 77H, scleromyxoedema 7.-.*H, !ioderma gangrenosum
.3- ..H, mi"sedema !retibial .,0H , eritema multiforme dan !soriasis 1H
)enyakit a7asaki
enya"it a#asa"i adalah ana" demam !enya"it vas"ulitis a"ut, !ertama "ali di+elas"an diEe!ang !ada tahun 1F0 oleh $r omas"o a#asa"i *- AH 6enyusul !enurunan !enya"it
+antung remati", !enya"it a#asa"i adalah !enyebab !aling umum dari !enya"it arteri "oroner
yang di!eroleh di negara ma+u Ge+ala-ge+ala termasu" demam ber"e!an+angan, "on+ungtivitistida" bernanah bilateral, ruam eritematosa !olymor!hus, !erubahan mu"osa mulut dan edemadan "emerahan !ada e"stremitas dengan des"uamasi ter"ait dari tangan dan "a"i ada saat yang
sama terung"a! bah#a banya" !asien mengembang"an "elainan arteri "oroner se!erti
aneurisma, terdete"si !ada e"o"ardiografi 4al ini di"ait"an dengan ting"at "ematian yangsignifi"an dari infar" mio"ard a"ut
da ham!ir 300 !ubli"asi termasu" u+i coba ter"ontrol dan revie# 9ochrane !ada !enggunaan
IVIG !ada !enya"it ini - 7H esim!ulan adalah bah#a ana"-ana" yang memenuhi "riteria
diagnosti" untu" !enya"it a#asa"i harus diberi"an sebagai !engobatan lini !ertama dosistunggal * g > "g IVIG dalam #a"tu 10 hari dari timbulnya ge+ala
+ekrolisis epidermal toksik
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