There must be a diagnosis of ITP and one of the following three:
- major bleeding and platelet count less than 50 x 109/L; or
- failed to respond to steroids after 3 or more days
- rapid elevation of platelets required for surgery
Dose
Acute:
1 g/kg per day for 2 consecutive days
Chronic:
1-2 g/kg no more frequently than every 2 weeks
Corticosteroids and IVIG are the first line treatments for maternal ITP. IVIG should be considered if corticosteroid therapy is ineffective, significant side effects occur with steroids or a more rapid platelet increase is required.
Must meet 1 of the following 3 criteria during the first 2 trimesters:
- when the patient is having a major bleed,
- when platelet counts fall below 10 x 109/L, anytime in the pregrancy OR
10-30x109/L during the second or third trimester. - rapid elevation of platelets required before delivery.
Dose
1 g/kg per day for 2 consecutive days
Patient must be under the care of a Hematologist
Dose
0.4 g/kg every 3 to 4 wks
Reevaluation should be done every 4 – 6 months by a hematologist. A trough IgG level of greater than 7 g/L should be maintained. Consideration should be given to increasing the target trough level if an appropriate clinical response is not achieved. Using trough IgG levels may not be practical in patients with secondary immunodeficiencies with IgG subclass deficiency and who experience recurrent severe infections. In such cases it would be sufficient to assess the effectiveness of IVIG based on clinical response.
No criteria are required other than a diagnosis of PTP
Dose
1 g/kg repeat if necessary
Patient must be under the care of a Hematologist
Dose
2 g/kg divided over 2 to 5 days
Patient must be under the care of a Hematologist
Dose
2 g/kg divided over 2 to 5 days
Patient must be resistant to stereoids and exhibit symptomatic anemia
Dose
up to 2 g/kg
Consult immunologist or physician experienced managing immunodeficiencies before administering IVIG/SCIG.
Monitor IgG every 5 months to achieve a minimum trough of 7g/L in most patients. After the IgG levels are stable, regularly monitor the levels and adjust the dose as needed.
Dose
0.4 - 0.6 g/kg every 4 weeks.
Consult immunologist or physician experienced managing immunodeficiencies before administering IVIG/SCIG.
IG is only considered appropriate if patient has/had recent life threatening or recurrent clinically significant infection(s) related to low levels of polyclonal immunoglobulin.
Dose
0.4 to 0.6 g/kg every 4 weeks.
Patient must meet both of the following criteria:
- has failed to respond or has contraindications to high dose antihistamines
AND - failed to respond or has contraindications to Xolair® (if covered)
Dose
Induction: 1 g/kg per day fpr 3 consecutive days
Maintenance: 1 g/kg every 4 weeks
Patient must be under the care of a Neurologist
Dose
2 g/kg divided over 2 to 5 days
Maintenance dose: 1 g/kg every 2 to 6 weeks
Patient must meet both of the following criteria:
- IVIG is being given within 2 weeks of the symptoms onset
AND - Hughes Disability Score of Grade 3 severity or greater OR patients with less than Grade 3 severity whose symptoms are progressing
Hughes Disability Scale:
Grade | Description |
0 | healthy |
1 | minor signs or symptoms, able to run |
2 | able to walk 5 m independently |
3 | able to walk 5 m with a walker, stick, or one-person support |
4 | bed- or chair-bound |
5 | Requiring assisted ventilation |
Dose
2 g/kg divided over 2 to 5 days
NO criteria are required other than a diagnosis of MMN
Dose
Acute: 2 g/kg divided over 2 to 5 days
Maintenance: 1 g/kg every 2 to 6 weeks
Patient must meet 1 of the following 2 criteria:
- Pregnant/immediate post partum period when other immunomodulation is contraindicated
OR - relapsing/remitting MS who fail or have contraindications to standard immunomodulatory therapies
Dose
1 g/kg monthly with or without a 5 day induction of 0.4 g/kg daily
Patient must meet 1 of the following 3 criteria
- acute exacerbation (myasthenic crisis)
OR - optimization prior to surgery and/or thymectomy
OR - as maintenance therapy for moderate to severe MG in combination with immunosuppressive agents
Dose
2 g/kg divided over 2 to 5 days every 4 to 6 weeks
Patient has failed or has contraindications to GABAergic medications
Dose
2 g/kg divided over 2 to 5 days every 4 to 6 weeks
Patient must meet both of the following criteria:
- cared for in consultation with a Neurologist
AND - used in conjuction with immunosupressives and/or plasmapheresis
Dose
2 gk/kg divided over 2 to 5 days
IVIG is used as a short term temporizing measure
Dose
2 g/kg divided over 2 to 5 days
Patient has failed or has contraindications to steroids
Dose
2 g/kg divided over 2 to 5 days
Patient must be under the care of a Neurologist
Dose
Induction dose: 2 g/kg in 2 to 5 divided doses
Maintenance dose: 0.4 to 1 g/kg every 2 to 6 weeks
Patient has failed or has contraindications to plasma exchange and/or steroids
Dose
1-2 g/kg in 2 to 5 divided doses
Patient must meet both of the following criteria:
- treated withing 1 month of symptom onset
AND - used in conjuction with chemotherapy treatment
Dose
2 g/kg every 4 to 6 weeks
Patient failed to respond or has contraindications to corticosteroids.
Dose
0.4 g/kg/day for 5 consecutive days every 4 weeks
Patient must be under the care of a Dermatologist.
Dose
2 g/kg every 4 weeks
Patient must meet both of the following criteria
- Has failed to respond or has contraindications to high dose antihistamines
AND - Failed to respond or has contraindications to Xolair®(if covered)
Dose
Induction dose: 1 g/kg/day for 3 days
Maintenance dose: 1 g/kg every 4 weeks
Patient must meet both of the following criteria:
- Has significant muscle weakness
AND - Failed to respond or has contraindications to corticosteroids
Dose
2 g/kg divided over 2 to 5 days
Patient failed to respond or has contraindications to corticosteroids.
Dose
2 g/kg every 4 weeks
Patient failed to respond or has contraindications to intralesional and oral steroids.
Dose
2 g/kg every 4 weeks
Patient must meet both of the following criteria.
- Is under the care of a Dermatologist
AND - Failed to respond or has contraindications to systemic steroids
Dose
2 g/kg every 4 weeks
(Pemphigus vulgaris, Pemphigus foliaceus, Pemphigoid, Cicatricial Pemphigoid, Linear IgA disease, Epidermolysis bullosa acquisita, Pemphigoid gestationis)
Patient must meet both of the following criteria.
- Disease is rapidly progressing
AND - Failed to respond or has contraindications to systemic steroids
Dose
2 g/kg every 4 weeks
Patient failed to respond or has contraindications to corticosteroids
Dose
2 g/kg every 4 weeks
Patient must meet 1 of the following 2 criteria
- Failed to respond or has contraindications to corticosteroids with/without immunosuppressive therapies
OR - The presence of life-threatening disease
Dose
Initial dose: 2 g/kg divided over 2 to 5 days every 4 to 6 weeks
Taper when disease stable
Patient must be under the care of a Rheumatologist
Dose
2 g/kg divided over 2 to 5 days
Patient must be under the care of a Rheumatologist
Dose
2 g/kg divided over 2 to 5 days
Patient must be under the care of a Rheumatologist
Dose
2 g/kg divided over 2 to 5 days
Patient must be under the care of a Rheumatologist
Dose
2 g/kg divided over 2 to 5 days
Patient must be treated with a combination therapy of antibiotics and IVIG
Dose
1 g/kg on day 1 and 0.5 g/kg per day on days 2 and 3 OR 0.15 g/kg per day for 5 days
Patient must be treated with a combination therapy of antibiotics and IVIG
Dose
1 g/kg on day 1 and 0.5 g/kg per day on days 2 and 3 OR 0.15 g/kg per day for 5 days
Immunocomprised patient with HPV-B19 Pure Red Cell Aplasia
Dose
Initial dose: 2 g/kg
Maintenance dose: 0.4 -1 g/kg every 4 weeks
Give IVIG with plasmapheresis to improve graft survival.
Dose
IVIG is commonly administered as part of a treatment protocol that includes plasmapheresis. Regimens for administration include IVIG after each plasmapheresis treatment or as a set dose of 2 g/kg total, alone or if given with plasmapheresis after the final plasmapheresis treatment. There is no comparative data to indicate which of these approaches are superior.
Patient must meet both of the following criteria:
- Mother had a previously affected pregnancy OR has a family history of F/NAIT OR has been found to have platelet alloantibodies
AND - Treatment is under the direction of a maternal fetal medicine center
Dose
1 g/kg per week throughout the pregnancy
Treatment includes consultation with or is within a high-risk neonatal center
Dose
1 g/kg per day x 2 days
Total serum bilirubin (TSB) rising despite intensive phototherapy
Dose
0.5 to 1 g/kg, with repeat dosing every 12-24 hours as necessary
Patient must meet 1 of the following 2 criteria:
- Platelets less than 50 x 109/L AND either the presence of major bleeding or surgery required
OR - Platelets less than 20 x 109/L AND treatment clinically indicated
Dose
0.8 to 1 g/kg, with a 2nd dose within 48 hours if the platelet count has not increased to above 20 x 109/L
Patient must meet 1 of the following 2 criteria:
- Platelets less than 50 x 109/L
OR - Imaging evidence of intracranial hemorrhage or other serious bleeding
Dose
1 g/kg daily for 2 days with a second dose of 1 g/kg if platelet count is still less than 30 x 109/L
Patient must meet criteria number 1 and either criteria number 2 or 3:
- Acquired hypogammaglobulinemia
PLUS - History of severe invasive or recurrent sinopulmonary infections
OR - Registered on a multinational protocol which requires IVIG support
Dose
0.4 to 0.6 g/kg every 3 to 4 weeks
Patient must be under the care of a pediatric Hematologist
Dose
0.4 g/kg every 3 to 4 weeks
Patient must be under the care of an Immunologist.
Dose
0.3 to 0.6 g/kg every 4 weeks
Patient must be under the care of an Immunologist
Dose
0.6 to 0.7 g/kg every 3 to 4 weeks
Patient must meet both of the following criteria:
- IVIG is being given within 2 weeks of symptom onset
AND - Hughes Disability score of 3 or more or less than 3 with symptoms progressing
Grade | Description |
0 | healthy |
1 | minor signs or symptoms, able to run |
2 | able to walk 5 m independently |
3 | able to walk 5 m with a walker, stick, or one-person support |
4 | bed- or chair-bound |
5 | Requiring assisted ventilation |
Dose
2 g/kg divided over 2 to 5 days
Patient must meet 1 of the following 3 criteria:
- Acute exacerbation (myasthenic crisis)
OR - Optimization prior to surgery and/or thymectomy
OR - As maintenance therapy for moderate to severe MG in combination with immunosuppressive agents
Dose
2 g/kg divided over 2 to 5 days
Patient failed to respond or has contraindications to corticosteroids
Dose
1 g/kg daily for 2 days every 4 to 6 weeks
Patient must meet both of the following criteria
- Cared for in consultation with a pediatric Neurologist
AND - Used in conjunction with immunosuppressives and/or plasmapheresis
Dose
1 g/kg daily for 2 days
IVIG is used as a short term, temporizing measure
Dose
2 g/kg daily for 2 days
Patient must be cared for in consultation with a pediatric Neurologist
Dose
1 g/kg daily for 2 days
Patient must meet both of the following criteria:
- Glucocorticoids and other 2nd line agents are contraindicated OR IVIG is part of early therapy in a critically ill child
AND - Is under the care of a pediatric Rheumatologist
Dose
2 g/kg every 2 to 4 weeks
No criteria are required other than a diagnosis of Kawasaki Syndrome
Dose
2 g/kg given once
If failure to respond to initial dose, a 2nd dose may be given at least 24 hours after the 1st dose.
Patient must meet both of the following criteria:
- Is resistant to other forms of therapy
AND - Is under the care of a pediatric Rheumatologist
Dose
1 to 2 g/kg every 2 to 4 weeks
No criteria are required other than a diagnosis of Kawasaki Syndrome
Dose
2 g/kg given once
If failure to respond to initial dose, a 2nd dose may be given at least 24 hours after the 1st dose
Patient failed to respond or has contraindications to corticosteroids
Dose
0.4 g/kg/day for 5 consecutive days every 4 weeks
Patient must be under the care of a Dermatologist
Dose
2 g/kg every 4 weeks
Patient must meet both of the following criteria:
- Failed to respond or has contraindications to high dose antihistamines
AND - Failed to respond or has contraindications to Xolair®(if approved)
Dose
Induction dose: 1 g/kg/day for 3 days
Maintenance dose: 1 g/kg every 4 weeks
Patient must meet both of the following criteria:
- Has significant muscle weakness
AND - Failed to respond or has contraindications to corticosteroids
Dose
2 g/kg over 2 days
Patient failed to respond or has contraindications to corticosteroids
Dose
2 g/kg every 4 weeks
Patient failed to respond or has contraindications to topical steroids and calcineurin inhibitors
Dose
2 g/kg every 4 weeks
Patient failed to respond or has contraindications to intralesional and oral steroids
Dose
2 g/kg every 4 weeks
Patient must meet both of the following criteria:
- Is under the care of a Dermatologist
AND - Failed to respond or has contraindications to systemic steroids
Dose
2 g/kg every 4 weeks
(Pemphigus vulgaris, Pemphigus foliaceus, Pemphigoid, Cicatricial Pemphigoid, Linear IgA disease, Epidermolysis bullosa acquisita, Pemphigoid gestationis)
Patient must meet both of the following criteria:
- Disease is rapidly progressing
AND - Failed to respond or has contraindications to systemic steroids
Dose
2 g/kg every 4 weeks
Patient failed to respond or has contraindications to corticosteroids
Dose
2 g/kg every 4 weeks
Patient must be treated with a combination therapy of antibiotics and IVIG
Dose
1 g/kg on day 1 and 0.5 g/kg per day on days 2 and 3 OR 0.15 g/kg per day for 5 days
Patient must be treated with a combination therapy of antibiotics and IVIG
Dose
1 g/kg on day 1 and 0.5 g/kg per day on days 2 and 3 OR 0.15 g/kg per day for 5 days
Immunocomprised patient with HPV-B19 Pure Red Cell Aplasia
Dose
Initial dose: 2 g/kg
Maintenance dose: 0.4 -1 g/kg every 4 weeks
Patient must meet the following criterion:
Pathology proven acute antibody mediated rejection IVIG is commonly administered as part of a treatment protocol that includes plasmapheresis.
Regimens for administration include IVIG after each plasmapheresis treatment as a set dose of 2 g/kg total, alone or if given with plasmapheresis after the final plasmapheresis treatment