Transcript RANP Haematology

Teresa Meenaghan
RANP Haematology
16thOctober HAI
Disease
Treatment
 Conducted an Audit of patients on monthly IVIG
 43 patients with secondary immune suppression
 Need
 Capacity issue
 Investigate alternative management
Attended conference in Dublin at the end of July
50% Haematology
50% Immunology
Reviewed
Benefits
Procedure
Case reviews
 Dr Ogden Bruton, USA, published in 1952 the first
case of proven PID (antibody deficiency) in a 4year old boy
 He demonstrated the lack of antibodies in the boy
and the normalized level after the initiation of the
subcutaneous injections
•Infusion of IgG into subcutaneous tissue using an
ambulatory infusion pump or syringe driver
•Weekly dose = ¼ monthly IVIG dose
•Monthly Dose: Full monthly dose can be
administered subcutaneously
•Can be self-administered
• Letter for funding (patients name, address and date of birth. The
most important information is if the patient has a medical card or
a long term illness card or a drug payment scheme card. Need to
write number of whichever card they have. Funding letter must be
printed on Hospital headed paper and signed by referring
consultant.
 Consultant letter optional
 Prescription (The prescription should state, name of drug dose per
month, frequency (once a month, once every 3 weeks etc.)Length
of prescription max is 6 months
 The funding letter can be faxed, emailed or posted back to Ms.
Aoife Murphy, Homecare Services Co-Ordinator, Baxter
Healthcare Ltd, Deansgrange Business Park, Deansgrange Co.
Dublin Email: [email protected] Fax no: 012065583
.
Once funding has been approved the homecare nurse will commence
training one week after the last dose of IVIG.
Training occurs over a period of 7 weeks. See example below of a
training schedule for a patient receiving 40gs every 4 weeks.
Start fSCIG
1 week following last
IVIG or SCIG dose
fSCIG
Infusion
Number
Dose of the Ig 10% Component of fSCIG
Week 1
1
1-week dose
Week 2
2
2-week dose
Week 3
Week 4
No infusion
3
3-week dose
Week 5
No infusion
Week 6
No infusion
Week 7
4
(If required)
4-week dose
 Patient is then discharged home with home visit for
next 2 doses
 While patient is been trained in hospital the pharmacy
need to supply the drug for the training weeks and
then the cost is taken over by local health board once
they go home.
 All the pumps etc that the patient needs for infusion
are supplied by the drug company. Deliveries are done
every 12 weeks
 Some products are a fridge product so a fridge is also
supply to the patient.
• Infused using syringe drivers
• Initial speed: 10 mL/h/pump
• For each subsequent infusion
speed can be increased
• Maximum speed: varies from country to country
• More than one pump can be used simultaneously; sites
at least 10 cm apart
• Butterfly or Thumb needles are used
• Placed under the skin at angles of 45 degrees for
butterfly and thumb needles at 90 degrees.
• SCIG is infused into the abdominal wall or thigh
• The use of more than one syringe driver
simultaneously can reduce infusion time.
Preinfusion
50 mL fSCIG

100 mL fSCIG
fSC
150 mL fSCIGG
200 mL fSCIG
24 hours
postinfusion
Immediately Post 1st Infusion
Infusion Sites: 1
Dose: 12.5g/125mls
Needle: 12mm length
Immediately Post 2nd Infusion
Infusion Sites: 1
Dose: 22.5g/225mls
Needle: 12mm Length
Immediately post 3rd Infusion
Infusion Sites: 2
Dose: 37.5g/375mls
Needle: 12mm length
Immediately post 4th Infusion
Infusion Sites: 1
Dose: 45g/450mls
Needle: 14mm Length
 Proven to show that trough IgG concentration levels
are comparable with those receiving IVIG
 Outbreaks of Hepatitis C has been associate with IV
products but to date none has been reported with S/C
administration
Possible advantages
• No venous access required
• Convenient & well tolerated
• Facilitates self infusion or
home infusions
• Shorter infusion times
• Greater patient
independence
• Often the choice for
paediatric patients
Possible Disadvantages
• Funding
• Weekly infusions
• Redness 5 itching at
infusion sites (usually
quickly resolves)
 SCIG a very real alternative to IV treatment
 Patient choice & control over their condition /
treatment
 Higher doses not a problem
 Easy & quick for to teach
 Method of choice for home therapy in many countries
Birte, M., Bernatowska, H.D., Roifman, C.M. (2011) Efficacy
and safety of home-based subcutaneous immunoglobulin
replacement therapy in paediatric patients with primary
immunodeficiencies. British Society for Immunology,
Clinical and Experimental Immunology, 164(1)357-354.
Framme, J.L.& Fasth, A. (2013) Subcutaneous
Immunoglobulin for primary and Secondary
Immunodeficiencies: an Evidence Based Review. Drugs,
73(1)1307-1319.
Gaspar, J., Gerritsen, B. & Jones, A. (1998) Immunoglobulin
replacement treatment by rapid subcutaneous infusion.
British Medical Journal, 79(1)48-51.