IMMUNOLOGY NURSING

AT

AUCKLAND CITY HOSPITAL AUCKLAND

NEW ZEALAND - AOTEAROA

SANCHIA VOS

CLINICAL NURSE SPECIALIST

21 DISTRICT HEALTH BOARDSPopulation of 4.2 million-http://www.stats.govt.nz/

GEOGRAPHICAL AREA SERVED

Consultants: 3 part-timeFellow: 1 full-timeRegistrar: 1 full-timeCNS: 1 full-timeRN research: 1 part-timeDietician: 1 part-time

One of our CVID patients receiving IVIG replacement therapy

The Day Ward

PATIENTS ON Ig REPLACEMENT

CVID (37)

BRUTONS (2)

GOODSSYNDROME (1)HYPER IgM (1)

HYPER IgE (1)

CHURG-STRAUSS (1)IgG SUBCLASSDEF (1)

INTRAGAM®P (Human immunoglobulin)

• Pooled plasma donated by NZ blood donors (Unique to NZ; plasma from other countries is not used to make the NZ product)

• Sent to CSL Bioplasma in Australia for processing and returned to NZ

• Resulting product is a sterile preservative free solution; 90% IgG, trace of IgA and IgM.

• Licensed in NZ as replacement therapy in PID & certain disease conditions e.g. Guillain-Barre syndrome, ITP.

IMMUNOGLOBULIN REPLACEMENT THERAPY

Calculated at 400mg/kg body weight 74% intravenous IgG (IVIG) 3-4 weekly

infused through peripheral vein via electronic infusion pump

no after hour service work time lost stigma – visible evidence – impact choice of venous

access

21% home subcutaneous infusions (SCIG) Graseby syringe drivers CSL Bioplasma trial in progress

5% home IVIG infusions

Auckland DHB Quarterly Issues by Product by Speciality

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Intragam P (200ml eq.) - Immunology Linear (Intragam P (200ml eq.) - Immunology)

ADVERSE EVENTS

• Rare: – patient with anti-IgA antibodies; risk of haemolysis

• Often related to infusion rate: – infusions commenced at 60ml/hour, increased every 15 min by 60ml if

patient tolerant to a maximum rate of 240ml/hour

– those demonstrating side-effects rate not more than 150ml/hour

– premedication with antihistamine and paracetamol effective ( or NSAID)

• Observed events:– hypertension, back pain, rigor and headache

• Reported:– lethargy and mild backache 12 to 24 hrs post infusion

SUPPORT GROUPS

The Immune Deficiencies Foundation of New Zealand (member of IPOPI) www.idfnz.org.nz

ACKNOWLEDGMENTS

A sincere thank you to Dr Penny Fitzharris (Clinical Director) and Dr Miriam Hurst (Immunology Fellow).

REFERENCES/RESOURCES

• www.stats.govt.nz

• www.nzblood.co.nz