ALMOST as soon as a therapeutically useful concentrated immune globulin product became available for intramuscular use, it was obvious that a preparation that could be administered intravenously would be advantageous.1 , 2 However, many years of immunochemical research were required before a concentrated, biologically active, and safe preparation of immune globulin suitable for intravenous use became available. In the past decade, chemists have learned how to prevent protein aggregation while concentrating immune globulin. Purification can be achieved by chromatography, and stabilization of the intact immune globulin is then promoted by acidification with pepsin or the addition of sugars, amino acids, or both. . . .

Manipulating the Immune System with Immune Globulin

Prednisone treatment for infertility and subsequent pregnancy maintenance in humans resulted in a significant decrease in the birth weight of full-term infants and a marked increase in the percentage of newborn infants weighing 2500 grams or less, that is, "light for dates" in comparison to control offspring. A parallel experiment with mice indicated that the reduction of birth weight was caused by exposure to corticosteroids rather than to maternal disease or malfunction.

Prenatal Exposure to Prednisone in Humans and Animals Retards Intrauterine Growth

Intravenous immunoglobulins are stable monomeric pooled human IgG preparations for therapeutic use. Three intravenous immunoglobulins licensed in the United States are generally therapeutically equivalent. Intravenous immunoglobulin is the preferred agent for replacement therapy for most patients with primary or secondary antibody immunodeficiency because of the rapidity and ease of giving large quantities of IgG, even by self-administration. Disadvantages of intravenous immunoglobulins include frequent (approximately 10%) but usually not serious side effects, the need for venous access (often difficult in infants and young children), and high cost. Intravenous immunoglobulins are also beneficial in the prevention of certain viral infections, such as cytomegalovirus pneumonia and varicella; they may also have a synergistic effect with antibiotics in certain bacterial diseases. Intravenous immunoglobulin has also been used successfully in the management of idiopathic thrombocytopenia purpura, Kawasaki disease, and certain autoimmune diseases. Intravenous immunoglobulin may also be of use in certain high-risk and premature newborns.

Intravenous immunoglobulins as therapeutic agents.

The general effect of pregnancy on autoimmunity remains controversial. In the majority of cases, pregnancy may have no effect on the disease, while on other occasions, pregnancy induces exacerbations that may be especially pronounced in the immediate post-partum period. The reasons for this preponderance are still unclear. Another important aspect of autoimmune diseases during pregnancy entails the passive transfer of the disease into the fetal compartment. It seems that until the pathogenesis and a better specific therapy for autoimmune diseases are clearly defined, careful clinical and immunologic observation of each mother-infant pair will be invaluable.

Autoimmunity and Pregnancy

Autoimmune thrombocytopenic purpura: Current concepts and recommended practices

ITP in pregnancy may lead to fetal thrombocytopenia caused by the transplacental passage of maternal antiplatelet antibody. The most hazardous complication in the infant is intracranial hemorrhage. In addition ITP in pregnancy is reported to be associated with an increased abortion rate and an elevated fetal morbidity and mortality. Therefore obstetric management must aim at increasing maternal and fetal platelets. Severel therapeutic approaches to the treatment of ITP in pregnancy are evaluated. Two cases of ITP in pregnancy are reported. Administration of high-dose intravenous immunoglobulin is introduced as a new therapy for ITP in pregnancy. The rapid reversal of thrombocytopenia following immunoglobulin G administration suggests that it is useful especially as emergency treatment for ITP in pregnancy.

Treatment of idiopathic thrombocytic purpura in pregnancy by high-dose intravenous immunoglobulin.

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Treatment of idiopathic thrombocytic purpura in pregnancy by high-dose intravenous immunoglobulin.