cytomegalovirus immune globulin


globulin

 [glob´u-lin] any of numerous proteins that are insoluble in water or highly concentrated salt solutions but soluble in moderately concentrated salt solutions. All plasma proteins except albumin and prealbumin are globulins. The plasma globulins are separated into five fractions by serum protein electrophoresis (SPE). In order of decreasing electrophoretic mobility these fractions are the alpha1-, alpha2-, beta1-, and beta2-globulins, and the gamma globulins.
The globulins include carrier proteins, which transport specific substances; acute phase reactants, which are involved in the inflammatory process; coagulation factors; complement components; and immunoglobulins. Examples are transferrin, a beta1-globulin that transports iron, and alpha1-antitrypsin, an acute phase reactant that inhibits serum proteases. The gamma globulin fraction is almost entirely composed of immunoglobulins.accelerator globulin factor V, one of the coagulation factors.antihemophilic globulin (AHG) factor VIII, one of the coagulation factors.antilymphocyte globulin (ALG) the gamma globulin fraction of serum" >antilymphocyte serum; used as an immunosuppressant in organ transplantation. The term is sometimes used interchangeably with antithymocyte globulin.antithymocyte globulin (ATG) the gamma globulin fraction of antiserum derived from animals (such as rabbits) that have been immunized against human thymocytes; an immunosuppressive agent that causes specific destruction of T lymphocytes, used in treatment of allograft rejection. The term is sometimes used interchangeably with antilymphocyte globulin.bacterial polysaccharide immune globulin (BPIG) a human globulin" > immune globulin derived from the blood plasma of adult human donors immunized with Haemophilus influenzae type b, pneumococcal, and meningococcal polysaccharide vaccines; used for passive immunization of infants under 18 months of age.cytomegalovirus immune globulin a purified immunoglobulin derived from pooled adult human plasma selected for high titers of antibody against cytomegalovirus; administered intravenously for treatment and prophylaxis of cytomegalovirus disease in transplant recipients.gamma globulin 1. see gamma globulin.2. immune globulin.hepatitis B immune globulin (HBIG) a globulin" >specific immune globulin derived from plasma of human donors with high titers of antibodies against hepatitis B surface antigen (HBsAg); used for postexposure prophylaxis following contact with HBsAg-positive materials, also administered to infants of HBsAg-positive mothers.hyperimmune globulin any of various globulin" >immune globulin preparations especially high in antibodies against certain specific diseases.immune globulin 1. immunoglobulin.2. a concentrated preparation containing mostly gamma globulins, predominantly IgG, from a large pool of human donors; used for passive immunization against measles, hepatitis A, and varicella and for treatment of hypogammaglobulinemia or agammaglobulinemia in immunodeficient patients, administered intramuscularly. See also immune g. intravenous (human).immune globulin intravenous (human) a preparation of globulin" >immune globulin suitable for intravenous administration; used in the treatment of primary immunodeficiency disorders and idiopathic thrombocytopenic purpura, and as an adjunct in the treatment of Kawasaki disease and the prevention of infections associated with chronic lymphocytic leukemia, bone marrow transplantation, and pediatric human immunodeficiency virus infection.immune human serum globulin immune globulin (def. 2).immune serum globulin immune g. (def. 2).pertussis immune globulin a globulin" >specific immune globulin derived from the blood plasma of human donors immunized with pertussis vaccine; used for the prophylaxis and treatment of pertussis.rabies immune globulin a globulin" >specific immune globulin derived from plasma of human donors hyperimmunized with vaccine" >rabies vaccine; administered in conjunction with rabies vaccine in cases of bite or scratch exposure to known or suspected rabid animals.respiratory syncytial virus immune globulin intravenous a preparation of immunoglobulin G from pooled adult human plasma selected for high titers of antibodies against virus" >respiratory syncytial virus; used for passive immunization of infants and young children.Rh0(D) immune globulin a globulin" >specific immune globulin derived from human blood plasma containing antibody to the erythrocyte factor Rh0(D); used to prevent Rh-sensitization of Rh-negative females and thus prevent erythroblastosis fetalis in subsequent pregnancies; administered within 72 hours after exposure to Rh-positive blood resulting from delivery of an Rh-positive child, abortion or miscarriage of an Rh-positive fetus, or transfusion of Rh-positive blood. It is also used as a platelet count stimulator in the treatment of purpura" >idiopathic thrombocytopenic purpura.serum g's all plasma proteins except albumin, which is not a globulin, and fibrinogen, which is not in the serum. The serum globulins are subdivided into alpha-, beta-, and gamma-globulins on the basis of their relative electrophoretic mobilities.specific immune globulin a preparation of globulin" >immune globulin derived from a donor pool preselected for high antibody titer against a specific antigen, such as globulin" >hepatitis B immune globulin.tetanus immune globulin a globulin" >specific immune globulin derived from the blood plasma of human donors who have been immunized with toxoid" >tetanus toxoid; used in the prophylaxis and treatment of tetanus.thyronine-binding globulin (TBG) (thyroxine-binding globulin) an acidic glycoprotein that is the main binding protein in the blood for thyroxine, and less firmly for triiodothyronine.vaccinia immune globulin a globulin" >specific immune globulin derived from the blood plasma of human donors who have been immunized with vaccinia virus smallpox vaccine; used as a passive immunizing agent.varicella-zoster immune globulin (VZIG) a globulin" >specific immune globulin derived from plasma of human donors with high titers of varicella-zoster antibodies; used for prevention or amelioration of varicella in immunocompromised patients exposed to the disease and in neonates whose mothers develop varicella in the perinatal period.

cytomegalovirus immune globulin

(site-oh-meg-a-loe-vye-rus) cytomegalovirusimmuneglobulin,

CMVIG

(trade name),

CytoGam

(trade name)

Classification

Therapeutic: vaccines immunizing agents
Pharmacologic: immune globulins
Pregnancy Category: C

Indications

Prevention of cytomegalovirus (CMV) disease associated with transplantation of kidney, lung, liver, pancreas, or heart (if transplant is other than kidney from CMV-positive donors to CMV-negative recipient, then concurrent ganciclovir should be considered).

Action

Consists of IgG antibodies capable of providing passive immunity against CMV disease.

Therapeutic effects

Prevention of serious sequelae of CMV disease in transplant patients.

Pharmacokinetics

Absorption: Administered IV only, resulting in complete bioavailability.Distribution: Unknown.Metabolism and Excretion: Unknown.Half-life: 7 days.

Time/action profile (CMV antibody titers)

ROUTEONSETPEAKDURATION
IVrapidunknownunknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity to immune globulins or albumin; Selective IgA deficiency.Use Cautiously in: Obstetric / Lactation: Pregnancy or lactation (safety not established); Renal insufficiency or predisposition to acute renal failure.

Adverse Reactions/Side Effects

Central nervous system

  • headache
  • tremor
  • anxiety
  • seizures

Hematologic

  • pancytopenia
  • hemolysis
  • leukopenia

Respiratory

  • wheezing
  • dyspnea
  • pulmonary edema

Cardiovascular

  • hypotension
  • thromboembolism

Gastrointestinal

  • nausea
  • vomiting
  • hepatic dysfunction

Dermatologic

  • flushing
  • rash

Genitourinary

  • oliguria
  • anuria
  • acute renal failure

Musculoskeletal

  • back pain
  • muscle cramps

Miscellaneous

  • allergic reactions including chills
  • fever
  • anaphylaxis (life-threatening)

Interactions

Drug-Drug interaction

May interfere with immune response to some live-virus vaccines including measles, mumps, and rubella (MMR ; do not administer within 3 mo of immune globulin).

Route/Dosage

Kidney TransplantIntravenous (Adults) 150 mg/kg within 72 hr of transplantation, followed by 100 mg/kg at 2, 4, 6, and 8 wk, then 50 mg/kg at 12 and 16 wk post-transplantation.Liver, Pancreas, Lung, or Heart TransplantIntravenous (Adults) 150 mg/kg within 72 hr of transplantation, and at 2, 4, 6, and 8 wk, then 100 mg/kg after at 12 and 16 wk post-transplantation.Intravenous (Children) Safety and efficacy has not been established in pediatrics, however adult doses have been used in children.

Availability

Powder for injection: 1000-mg vial, 2500-mg vial

Nursing implications

Nursing assessment

  • Monitor vital signs prior to, during, and following infusion and before any increases in infusion rate.
  • Monitor patient for adverse reactions throughout therapy. If patient develops minor side effects (nausea, vomiting, muscle cramps, back pain, fever, flushing, chills), slow infusion rate or stop infusion temporarily. If hypotension or anaphylaxis occurs, stop infusion and administer treatment (epinephrine and diphenhydramine).

Potential Nursing Diagnoses

Risk for infection (Indications)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • Intravenous Administration
  • Intermittent Infusion: Reconstitute with 50 mL of sterile water for injection with a double-ended needle or large syringe. To avoid foaming, do not shake vial. If using a double-ended needle, insert into water first, as powder is supplied in an evacuated vial and water will transfer by suction. After sterile water is transferred, release residual vacuum to speed dissolution. Rotate gently to wet undissolved powder. Allow 30 min for powder to dissolve. Solution should be clear, colorless, and free of particulate matter. Infusion should be started within 6 hr and completed within 12 hr of reconstitution.
    • Administer via infusion pump through a separate IV line. If not possible, solution may be piggybacked in an IV line containing 0.9% NaCl, D5W, D10W, D20W, or combinations of dextrose and saline, but do not dilute to more than 1:2. Do not use filters.
  • Rate: Administer initial dose at 15 mg/kg/hr for first 30 min. If no adverse reactions occur, rate may be increased to 30 mg/kg/hr; if no adverse reactions occur in subsequent 30 min, rate may be increased to 60 mg/kg/hr. Do not exceed 75 mL/hr volume or 60 mg/kg/hr rate. Monitor patient closely during rate changes. May cause pain at injection site.
    • During subsequent doses, rate may be increased in same increments every 15 min if no adverse reactions occur, until 60 mg/kg/hr maximum is reached.

Patient/Family Teaching

  • Instruct patient to notify health care professional if any adverse reactions occur.
  • If live virus vaccines were administered within 14 days of immune globulin, vaccination should be repeated 3 mo after the last dose of immune globulin.

Evaluation/Desired Outcomes

  • Prevention of serious sequelae of CMV disease, including blindness, associated with transplantation of kidney, lung, liver, pancreas, or heart.