PMID- 27401495
OWN - NLM
STAT- MEDLINE
DCOM- 20170526
LR  - 20170526
IS  - 1537-2995 (Electronic)
IS  - 0041-1132 (Linking)
VI  - 56
IP  - 10
DP  - 2016 Oct
TI  - Improvement of hemoglobin levels after a switch from intravenous to subcutaneous 
      administration of immunoglobulin in chronic inflammatory demyelinating 
      polyneuropathy and multifocal motor neuropathy.
PG  - 2443-2448
LID - 10.1111/trf.13727 [doi]
AB  - BACKGROUND: Intravenous immunoglobulin (IVIG) is recommended treatment for 
      chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor 
      neuropathy (MMN). Recent studies have demonstrated that subcutaneous 
      immunoglobulin (SCIG) is feasible, safe, and effective in both disorders. IVIG 
      leads to transient hemolysis and, consequently, we hypothesized that frequent 
      small doses of SCIG exerts less hemolytic activity than a few larger doses of 
      IVIG. STUDY DESIGN AND METHODS: In an open-label study, 23 three patients treated 
      with IVIG for CIDP or MMN were switched to SCIG at an equal dosage. IVIG was 
      administered two to three times for 6 weeks. Two weeks after the last IVIG 
      infusion at Week 8, SCIG was initiated with injections twice or thrice weekly 
      until Week 20. Blood samples were drawn 2 weeks after IVIG at Weeks 2 and 8 and 
      during SCIG at Weeks 14 and 20 determining hemoglobin (Hb) and hemolytic 
      variables. RESULTS: Seventeen patients completed the study. At enrollment, the Hb 
      level was 138 +/- 12 g/L, haptoglobin level was 1.4 +/- 0.5 g/L, reticulocyte count 
      was 58.7 x 10(9)  +/- 21.3 x 10(9) /L, and bilirubin level was 6.6 +/- 2.3 micromol/L. 
      The average of the two blood samples drawn at comparable intervals during IVIG 
      and SCIG showed that Hb increased from 135 +/- 15 to 138 +/- 15 g/L (p = 0.03). 
      During IVIG the hemolytic variables showed signs of mild hemolysis that improved 
      during SCIG, haptoglobin increasing from 1.2 +/- 0.5 to 1.5 +/- 0.6 g/L (p = 0.002), 
      reticulocytes decreasing from 71.9 x 10(9)  +/- 35.8 x 10(9) to 54.5 x 10(9) 
       +/- 16.3 x 10(9) /L (p = 0.02), and bilirubin decreasing from 7.3 +/- 2.8 to 
      5.8 +/- 1.8 micromol/L (p = 0.001). CONCLUSION: A switch from IVIG to SCIG was 
      associated with a slight increase of Hb levels and an improvement of laboratory 
      variables related to hemolytic activity.
CI  - (c) 2016 AABB.
FAU - Markvardsen, Lars Hoj
AU  - Markvardsen LH
AD  - Department of Neurology, Aarhus University Hospital, Aarhus, Denmark. 
      larsmark@rm.dk.
FAU - Christiansen, Ingelise
AU  - Christiansen I
AD  - Department of Neurology, Rigshospitalet, Copenhagen University Hospital, 
      Copenhagen, Denmark.
FAU - Jakobsen, Johannes
AU  - Jakobsen J
AD  - Department of Neurology, Rigshospitalet, Copenhagen University Hospital, 
      Copenhagen, Denmark.
LA  - eng
PT  - Journal Article
DEP - 20160712
PL  - United States
TA  - Transfusion
JT  - Transfusion
JID - 0417360
RN  - 0 (Haptoglobins)
RN  - 0 (Hemoglobins)
RN  - 0 (Immunoglobulins)
SB  - IM
MH  - Administration, Intravenous
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Drug Administration Routes
MH  - Female
MH  - Haptoglobins/analysis
MH  - Hemoglobins/*analysis
MH  - Hemolysis
MH  - Humans
MH  - Immunoglobulins/*administration & dosage/therapeutic use
MH  - Infusions, Subcutaneous
MH  - Injections
MH  - Male
MH  - Middle Aged
MH  - Polyneuropathies/*drug therapy
MH  - Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/*drug therapy
MH  - Reticulocyte Count
EDAT- 2016/07/13 06:00
MHDA- 2017/05/27 06:00
CRDT- 2016/07/13 06:00
PHST- 2016/02/04 00:00 [received]
PHST- 2016/06/01 00:00 [revised]
PHST- 2016/06/05 00:00 [accepted]
PHST- 2016/07/13 06:00 [pubmed]
PHST- 2017/05/27 06:00 [medline]
PHST- 2016/07/13 06:00 [entrez]
AID - 10.1111/trf.13727 [doi]
PST - ppublish
SO  - Transfusion. 2016 Oct;56(10):2443-2448. doi: 10.1111/trf.13727. Epub 2016 Jul 12.