BNF advice on Immunoglobulins

Normal immunoglobulin

• 250mg vial, 750mg vial

Notes

1. Human normal immunoglobulin preparations for hepatitis A, measles, polio and rubella and specific immunoglobulin preparations for hepatitis B, rabies and varicella-zoster for intramuscular use are issued by the Communicable Disease Surveillance Centre (CDSC) and also by certain regional HPA and NHS laboratories

Antithymocyte Immunoglobulin (Rabbit) (Sanofi Aventis)

• Intravenous infusion 25mg vial

Notes

1. NICE TA481 and NICE TA482: Rabbit anti-human thymocyte immunoglobulin, is not recommended as an initial option to prevent organ rejection in children, young people, and adults having a kidney transplant. (October 2017)

Antithymocyte Immunoglobulin (Rabbit) (Fresenius)

• Intravenous infusion 100mg in 5ml (unlicensed preparation)

Antithymocyte Immunoglobulin (Equine) (Pfizer Atgam)

• Intravenous infusion 50mg in 1ml (unlicensed preparation

Disease-specific immunoglobulins

Hepatitis B immunoglobulin

• Advice on the usage and availability can be obtained from on call Microbiologist via Trust switchboard.

Rabies immunoglobulin

• Advice on the usage and availability can be obtained from the Consultant in Communicable Disease Control (CCDC) via on call Microbiologist.

Tetanus immunoglobulin

• Available in A&E department.
• Advice on the usage and availability can be obtained from on call Microbiologist.

Varicella-Zoster immunoglobulin (VZIG)

• Advice on the usage and availability can be obtained from on call Microbiologist.

Notes

1. Varicella–zoster immunoglobulin is recommended for individuals who are at increased risk of severe varicella and who have no antibodies to varicella–zoster virus and who have significant exposure to chickenpox or herpes zoster. Those at increased risk include:
   
   1. Neonates whose mothers develop chickenpox in the period 7 days before to 7 days after delivery;
   2. Susceptible neonates exposed in the first 7 days of life;
   3. Susceptible neonates or infants exposed whilst requiring intensive or prolonged special care nursing;
   4. Susceptible women exposed at any stage of pregnancy (but when supplies of VZIG are short, may only be issued to those exposed in the first 20 weeks' gestation or to those near term) providing VZIG is given within 10 days of contact;
   5. Immunocompromised individuals including those who have received corticosteroids in the previous 3 months at the following dose equivalents of prednisolone; children 2 mg/kg daily for at least 1 week or 1mg/kg daily for 1 month; adults about 40 mg daily for more than 1 week.
2. Please refer to Varicella (The Green Book; Chapter 34) for further information, including dosing and treatment regimens

Anti-D immunoglobulin

Human Anti-D immunoglobulin

• Refer to Trust Guidelines for the use of Anti-D immunoglobulin in pregnancy

Notes

1. NICE TA156: Routine antenatal anti-D prophylaxis for women who are rhesus D negative (August 2008)