Çocuk pratiğinde intravenöz immünglobülin kullanımı

Son yıllarda damar içine uygulanan insan kaynaklı intravenöz immünglobülinler (İVİG) birçok hastalığın tedavisinde yay- gın olarak kullanılmaktadır. İntravenöz immünglobülin diğer plazma kaynaklı ürünlerde olduğu gibi insan kaynaklı plazma havuzlarından elde edilir ve İVİG preparatları yapısal ve işlev- sel olarak bozulmamış immünglobülin içermektedir. İntra- venöz immünglobülin, ilk kez 1981 yılında Amerika Birleşik Devletlerinde FDA (Food and Drug Administration) onayı al- mış ve öncelikle hipogamaglobülinemi ile seyreden immün yetersizlik hastalarında kullanılmaya başlanmıştır. İntravenöz immünglobülin etkileri karmaşık mekanizmalar içerir ancak esas etkisini mononükleer fagositik sistemde bulunan özgül olmayan Fc almaçlarını yok ederek veya immünkompleksle- rin hücrelerdeki Fc almaçlarına bağlanmasını engelleyerek gösterir. Kullanım alanları, eksik olan immünglobülinin yeri- ne konulması dışında anti-enflamatuar ve immünmodülatör etkilerinden yararlanıldığı hastalıkları içerir. Kesin gerekçele- ri sınırlı olmakla beraber, klinikte bir çok hastalıkta olgu ba- zında yarar sağladığı gösterilmiştir. Yan etkileri arasında ateş, terleme, bulantı, kusma, taşikardi, egzamatöz reaksiyonlar, aseptik menenjit, böbrek yetersizliği ve hematolojik-trombo- embolik olaylar sayılabilir. Bu makalede İVİG kullanımı, etki mekanizmaları, gerekçeleri ve yan etkileri tartışılmıştır. (Türk Ped Arş 2014; 49: 282-8)

Use of intravenous immunoglobulin in pediatric practice

In recent years, human-driven intravenous immunoglobulins (IVIG) administered intravenously have been widely used in treatment of many diseases. Intravenous immunoglobulin is obtained from human-driven plasma pools as in other plas- ma-driven products and IVIG preperations contain structu- rally and functionally intact immunoglobulin. Intraveno- us immunoglobulin was approved by FDA (Food and Drug Administration) in USA in 1981 for the first time and was started to be primarily used in patients with immune defici- ency with hypogammaglobulinemia. The effects of intrave- nous immunoglobulin include complex mechanisms, but it exerts its essential action by eliminating the non-specific Fc receptors found in the mononuclear phagocytic system or by inhibiting binding of immune complexes to Fc receptors in the cells. Their areas of usage include conditions where their anti-inflammatory and immunomudulator effects are utili- zed in addition to replacement of deficient immunoglobu- lin. Although the definite indications are limited, it has been shown that it is useful in many diseases in clinical practice. Its side effects include fever, sweating, nausea, tachycardia, eczematous reactions, aseptic meningitis, renal failure and hematological-thromboembolic events. In this article, use of IVIG, its mechanisms of action, indications and side effects were discussed. (Türk Ped Arş 2014; 49: 282-8)

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