Variations in serum hemoglobin, albumin, and electrolytes in patients receiving intravenous immunoglobulin therapy: a real clinical threat?
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.


CONCLUSIONS
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.
Mignogna
Michele D
MD
Section of Oral Medicine, Department of Odontostomatological and Maxillofacial Sciences, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy. mignogna@unina.it
Fortuna
Giulio
G
Ruoppo
Elvira
E
Adamo
Daniela
D
Leuci
Stefania
S
Fedele
Stefano
S
D000328:Adult; D000368:Aged; D000418:Albumins / Q000032:analysis / Q000187:drug effects*; D016903:Drug Monitoring; D004573:Electrolytes / Q000097:blood*; D005260:Female; D006454:Hemoglobins / Q000032:analysis / Q000187:drug effects*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D007155:Immunologic Factors / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010390:Pemphigoid, Benign Mucous Membrane / Q000097:blood / Q000188:drug therapy*; D010392:Pemphigus / Q000097:blood / Q000188:drug therapy*; D018570:Risk Assessment
D000418:Albumins; D004573:Electrolytes; D006454:Hemoglobins; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors