Immune Globulin for Patients with Primary Immune Deficiency: An Evidence Based Practice Guideline

• Published in: Blood 2008-11, Vol.112 (11), p.4705-4705
• Main Authors: Shehata, Nadine, Hume, Heather Ann, Palda, Valerie, Anderson, David, Bowen, Tom, Warrington, Richard, Mazer, Bruce, Haddad, Elie, Issekutz, Thomas, Schellenberg, Bob, Easton, David
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.V112.11.4705.4705

Background: The original use of immune globulin (IG) was for replacement in patients with primary immune deficiency (PID). The evidence supporting this stems from the 19650s; however there have not been any rigorously developed evidence based clinical practice guidelines (CPGs) for the use of IG for PID. In 2007, Canadian Blood Services and the National Advisory Committee on Blood and Blood Products in Canada convened a panel of Canadian immunologists and a methodologist to develop a CPG for the use of IG in patients with PID. The objectives of this guideline are to examine the evidence for the use of IG in patients who have PID andto provide guidance for practitioners involved in the care of PID patients and transfusion medicine specialists on the use of IG. Methods: The panel identified key clinical questions and a systematic, expert and bibliography literature search up to July 2008 was conducted to ensure all relevant publications were included. The panel generated recommendations based on the evidence. The levels of evidence and grading of recommendations were adapted from the Canadian Task Force on Preventative Health Care. To validate conclusions and recommendations, the practice guideline will be sent to immunologists internationally and to a patient representative in September 2008. The guideline will be disseminated to all immunologists, internists and pediatricians in Canada to aid implementation of the guideline. The National Advisory Committee of Blood and Blood Products in Canada will assess the performance of the guideline and will renew the guideline at timely intervals. Results and Conclusions: The panel identified the following key clinical questions: what is the prevalence of the PIDs that require IG;does treatment with IG improve morbidity and mortality; andwhat criteria should be used to monitor the effectiveness of IVIG. The literature search was conducted in August 2007 and updated to July 2008. 1087 citations were reviewed. 101 reports, 1 systematic review and 3 consensus documents/guidelines were included. Current estimates suggest PID is under-diagnosed. Although more than 75% of patients require IG at some point in their treatment, the actual incidence of requiring IG is unknown. There is ample evidence that IG reduces infections, hospitalization and days lost from work/school. There is some evidence to suggest that IG may ameliorate chronic illnesses in patients with PID however, there is no data of the effect of IG on malignanc