Immunoglobulin Administration and Dilution

Introduction to Immunoglobulin Administration

The Centers for Disease Control and Prevention recommends that only immunoglobulin modified specifically for intravenous use (IGIV) can be administered intravenously, and intramuscular preparations (IG) should never be diluted or administered intravenously 1, 2, 3

The American Academy of Pediatrics states that intramuscular immunoglobulin is provided ready for use and does not require dilution, available in single-use vials (2 mL) and multidose vials (10 mL) without preservatives 4, 5
The Centers for Disease Control and Prevention recommends injecting intramuscular immunoglobulin directly into the deltoid or gluteal muscle using an appropriate needle length for the patient's age and size 4, 5

The Centers for Disease Control and Prevention recommends the following dosages for intramuscular immunoglobulin: 0.02 mL/kg for post-exposure hepatitis A prophylaxis, 0.02 mL/kg for pre-exposure hepatitis A prophylaxis for less than 3 months of protection, and 0.06 mL/kg for 3-5 months of protection 1, 4, 5, 6
The Centers for Disease Control and Prevention recommends the following dosages for intramuscular immunoglobulin: 0.25 mL/kg for measles prophylaxis in immunocompetent individuals, and 0.5 mL/kg for measles prophylaxis in immunocompromised individuals 1, 2, 7
The Centers for Disease Control and Prevention recommends 250 units of tetanus immunoglobulin (TIG) intramuscularly 1, 2, 3
The Centers for Disease Control and Prevention recommends 0.6 mL/kg of vaccinia immunoglobulin (VIG) intramuscularly, divided into multiple injections over 24-36 hours due to the large volume 1, 2, 3, 8, 9

The Centers for Disease Control and Prevention states that IGIV is provided as a lyophilized product that must be reconstituted with the specific diluent provided by the manufacturer before administration, and only the provided diluent should be used, never saline or other diluents 10
The American Academy of Pediatrics recommends the following dosages for IGIV: 300-400 mg/kg every 3-4 weeks for antibody deficiencies/primary immunodeficiencies, 400 mg/kg or 1000 mg/kg for idiopathic thrombocytopenic purpura (ITP), and 2 g/kg for Kawasaki disease 11

The Centers for Disease Control and Prevention states that absolute contraindications for immunoglobulin administration include IgA deficiency due to the risk of anaphylaxis after repeated administration, acute allergic reaction to thimerosal (for VIG IM), and history of severe reaction to human immunoglobulin preparations 4, 5, 8, 9
The American Academy of Pediatrics recommends that immunoglobulin administration interfere with the immune response to live attenuated vaccines, requiring specific intervals between IG and vaccination, such as delaying MMR vaccination for more than 3 months after IG for hepatitis A, and 5-6 months after IG for measles 11, 4, 5, 7, 10

The Centers for Disease Control and Prevention states that pregnancy and lactation are not contraindications for immunoglobulin administration 4, 5
The American Academy of Pediatrics recommends that the risk of viral transmission is extremely low, as plasma is tested for HBsAg, HIV, HCV, and processed with viral inactivation steps 4, 5, 8, 9