Passive Antibody Transfer May Occur Following IVIG Transfusion

An accurate interpretation of serological markers is vital in providing the appropriate treatment for patients following IVIG infusion, a recent study finds.

Published in the December 2014 edition of BMC Infectious Diseases, researchers note that before an immunosuppressive therapy for the treatment of autoimmune inflammatory conditions is initiated, screening for viral serology such as hepatitis B virus (HBV) is required, because a positive result may point to the need for antiviral therapy or may contraindicate immunosuppression.

The study presented the case of a 50-year-old man with a history of allogeneic haematopoietic stem cell transplant for transformed follicular lymphoma who had been admitted to the hospital for recurrent respiratory tract infections. He had also suffered from painful, swollen joints for the previous 3 weeks, which led to a diagnosis of seronegative inflammatory polyarthritis.

The patient was found to be hypogammaglobulinaemic and was subsequently administered 1 g/kg of intravenous immunoglobulin.

Viral screening detected HBV serology with positive results for both anti-HBc and anti-HBs antibody, but negative for HBV DNA. Unable to identify the source of infection, the case was reported to the local blood center, who then tested a vial from the same batch of IVIG, which was found to be anti-HBc and anti-HBs positive.

The blood product was identified and tested before HBV treatment was initiated.

“Misinterpretation of serology results following IVIG infusion may lead to significant patient harm, including unnecessary antiviral administration, the withholding of treatments, and psychosocial damage,” the study authors concluded. “This is especially pertinent at a time when we have an ever increasing number of patients being treated with IVIG for a wide array of immune-mediated disease. Passive antibody transfer should be considered wherever unexpected serological changes are identified.”