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Call for guidelines for monitoring renal function and haematological variables during intravenous infusion of immunoglobulin in neurological patients
  1. N P S BAJAJ,
  3. R BAHL,
  4. K STOTT,
  1. Departments of Neurology and Pharmacy, Hurstwood Park Neurological Centre (HPNC), Hurstwood Lane, West Sussex, UK
  1. Dr N P S Bajaj, Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1 3BG, UK narinderbajaj{at}

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Intravenous immunoglobulin (IVIg) is widely used in the treatment of some neurological conditions thought to have an underlying immune basis. Controlled studies of IVIg have demonstrated benefit in Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, and dermatomyositis. Treatment with IVIg has also been beneficial in myaesthenia gravis, multiple sclerosis, multifocal motor neuropathy with conduction block, polymyositis, Lambert-Eaton myaesthenic syndrome, stiff man syndrome, and Rasmussen's encephalitis.1

Various complications have been reported in the literature in association with IVIg therapy. These include headache, nausea, fever, rash, aches in the chest or limbs, anaphylaxis especially in association with IgA deficiency, leucopenia, neutropenia, autoimmune haemolysis, renal failure, thromboembolism, aseptic meningitis, and transmission of viral infections—for example, hepatitis C.1 The therapeutic dose of IVIg in the treatment of neurological disease has been empirically set at 2 g/kg, conventionally divided into five daily doses of 400 mg/kg, although some authors have shown that a 2 day infusion of 1 g/kg is not associated with any higher incidence of side effects than the 5 day infusion.2

Despite the widespread use of IVIg in neurological centres in the United Kingdom, to our knowledge there exists no consensus for advice either on monitoring haematological and renal function in patients pretreatment and post-treatment with IVIg, nor on the merits of shorter infusion periods of IVIg. Both of these factors have considerable cost implications for the National Health Service (NHS).

We have retrospectively examined the records of 21 patients admitted to a regional neurology centre …

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