Reza Nejat
Bazarganan Hospital, IRAN
Title: IVIG in Sepsis: Review article and case report of three critically ill patients with sepsis discharged in health
Biography
Biography: Reza Nejat
Abstract
Statement of the problem: Intravenous immunoglobulins (IVIG) contains immunoglobulins pooled from the plasma of 3000 to 10000 individual blood-donors. This preparation was developed originally in 1952 as a therapeutic milestone in primary hypo-gamma-globulinemia. IVIG has subsequently been proved to have therapeutic efficacy for an ever-growing number of conditions in diverse fields of medicine. Presuming the protective characteristic of its pluripotent antibody content, IVIg is expected to have explicit impact in sepsis, yet FDA has not approved and Surviving Sepsis Campaign Guidelines (SSCG) 2012 discouraged its administration in adult sepsis.
Methodology: By reviewing of relevant articles searched through internet from 1990 to 2016, the efficacy of IVIg as an adjuvant treatment in improving the outcome in systemic inflammatory response syndrome (SIRS) and sepsis was surveyed. Based on the literature it is discernible that SIRS and sepsis with high rate of mortality in ICUs are actually detrimental much more owing to dysregulated immune system responses overwhelmed by disarray of cytokines and chemokines, declining of endogenous immunoglobulins and even deranged activation or suppression of relevant gene domains. According to the latest definition of sepsis in 2016, this dysregulated host response to infection renders the scene toward organ dysfunction.
IVIg was given to three highly critically ill patients of 95, 37 and 11 years of age, with severe sepsis due to iatrogenic sigmoid perforation, post-ERCP necrotizing pancreatitis and severe multiple trauma following collision with a truck, respectively. Before administration of IVIg the patients was given intensive care with administration of appropriate antibiotics and keeping the energy, fluid and electrolytes in a balance mode. They all recovered from sepsis and were discharged in good health.
Conclusion: Based on this review article and case report, immune-modulatory characteristic of IVIG may restore the pathobiological host responses to normal and improve the outcome in sepsis.