USE OF INTRAVENOUS IMMUNOGLOBULIN IN VARIOUS MEDICAL CONDITIONS - A JAPANESE EXPERIENCE

The main clinical indications for intravenous immunoglobulin (IVIG) therapy in Japan are severe bacterial and viral infections as a result of primary and secondary immunodeficiencies, idiopathic thrombocytopenic purpura (ITP), autoimmune diseases, hematologic disorders, acquired immune deficiency syndrome, and Kawasaki disease. Experiences using IVIG to treat patients with severe infectious diseases, Kawasaki disease, and ITP are reported in this article. In patients with severe infections, IVIG showed some clinical benefits. In patients with Kawasaki disease, combined administration of IVIG and aspirin reduced the incidence of coronary artery lesions below that of aspirin alone or without therapy, and persistence of these lesions also decreased in patients who received combination therapy. Organ platelet sequestration, measured with indium 111-labeled platelets, showed a splenic pattern in good responders to IVIG, a hepatic pattern in fair responders, and a splenohepatic pattern in poor responders. These patterns might provide some insight into the use of IVIG. Some reaction mechanisms also are discussed.