Baseline Laboratory and Clinical Assessment Prior to IVIG Therapy

Essential Pre‑Infusion Laboratory Tests

Complete blood count (CBC) – Establishes a baseline to monitor for hemolysis and leukopenia during IVIG treatment. (American Society of Clinical Oncology) 1
Renal function panel (serum creatinine and estimated GFR) – Determines baseline kidney function because IVIG can precipitate acute renal failure, especially in patients with pre‑existing impairment. (American Society of Clinical Oncology) 1
Liver function tests (AST, ALT, alkaline phosphatase, total bilirubin, albumin) – Provides a baseline hepatic profile before IVIG administration. (American Society of Clinical Oncology) 1
Serum electrolytes (sodium, potassium, calcium, phosphorus) – Baseline assessment to detect metabolic disturbances that may be exacerbated by IVIG. (American Society of Clinical Oncology) 1
Baseline electrocardiogram (ECG) – Documents cardiac rhythm and identifies pre‑existing conduction abnormalities prior to infusion. (American Society of Clinical Oncology) 1
Coagulation studies (PT, PTT, fibrinogen) – Recommended when IVIG is used for hematologic conditions such as immune thrombocytopenia (ITP) or acquired hemophilia to assess bleeding risk. (American Society of Hematology) 2
Viral serology (HIV, HCV, HBV) – Important for patients with newly diagnosed ITP or primary immunodeficiency to guide infection‑related precautions. (American Society of Hematology) 3

Cardiac function assessment – Evaluate for heart failure, recent myocardial infarction, or significant cardiovascular disease because high‑dose IVIG can cause volume overload and precipitate congestive heart failure. (American College of Rheumatology) 4
Fluid‑status assessment – Identify patients at risk of volume overload; consider divided dosing (e.g., 1 g/kg per day over 2 days) for those with compromised cardiac function. (American College of Rheumatology) 5

Renal impairment criteria – Patients with estimated creatinine clearance < 30 mL/min or diabetic nephropathy have a heightened risk of IVIG‑induced acute renal failure. (American Society of Clinical Oncology) 6

Platelet count and peripheral smear – Establishes baseline severity of thrombocytopenia before IVIG for ITP or related disorders. (American Society of Hematology) 2
Direct antiglobulin test (Coombs) – Screens for concurrent Evans syndrome in patients with ITP. (American Society of Hematology) 2
Helicobacter pylori testing – Recommended in newly diagnosed ITP patients as eradication may improve platelet counts. (American Society of Hematology) 3
Bethesda unit measurement – Quantifies inhibitor titer in acquired hemophilia A to guide therapy. (American Society of Hematology) 3

Active infection screening – Document and treat any active infection before IVIG; fever occurring during infusion may reflect infection rather than an infusion reaction. (American Society of Clinical Oncology) 1

The American College of Rheumatology recommends checking IgA levels before first infusion to identify IgA deficiency, which carries risk of anaphylaxis from anti-IgA antibodies, in patients with impaired renal function and thrombotic risk 7, 8
Monitoring for thrombotic events during and after infusion is crucial, particularly in patients with cardiovascular risk factors, as recommended by the American Heart Association 7

The standard therapeutic dose for immune thrombocytopenia is 1 g/kg as a single dose, which may be repeated if necessary, according to the American Society of Hematology 9
For autoimmune conditions requiring rapid response, the recommended dose is 2 g/kg divided over 2-5 days, as suggested by the American College of Rheumatology 7, 10
The dose of 90 mg total over 2 days is considered severe underdosing, and standard dosing for a 30-35 kg child would be 30-70 grams total (1-2 g/kg), according to the American Academy of Pediatrics 11

The Centers for Disease Control and Prevention recommend administering the infusion over at least 2 hours when given through peripheral access 12
The American Academy of Allergy, Asthma, and Immunology suggests considering subcutaneous immunoglobulin as an alternative for difficult venous access 8

The American Heart Association recommends watching for anaphylaxis throughout infusion, especially in IgA-deficient patients 7, 8
Monitoring for thrombotic events, including deep vein thrombosis, pulmonary embolism, and stroke, is essential, as recommended by the American College of Cardiology 7
The American Academy of Allergy, Asthma, and Immunology suggests observing for infusion reactions, such as headache, chills, rigors, fever, and myalgia 13

The American College of Rheumatology recommends serial monitoring for patients on chronic therapy, with renal function assessed before each infusion cycle 7
The American Academy of Allergy, Asthma, and Immunology suggests monitoring IgG trough levels every 6-12 months (more frequently in growing children) 8

The American College of Obstetricians and Gynecologists recommends that pregnant patients requiring IVIG should receive either corticosteroids or IVIG, with mode of delivery based on obstetric indications rather than IVIG therapy 9

The Infectious Diseases Society of America recommends treating the underlying infection with antivirals first unless clinically significant bleeding is present in secondary ITP due to HIV 9
For HCV-associated ITP, the American Association for the Study of Liver Diseases prefers IVIG as the initial treatment with close platelet monitoring due to the risk of interferon-induced worsening 9