IMMUNOLOGY NURSING
AT
AUCKLAND CITY HOSPITAL AUCKLAND
NEW ZEALAND - AOTEAROA
SANCHIA VOS
CLINICAL NURSE SPECIALIST
21 DISTRICT HEALTH BOARDSPopulation of 4.2 million-http://www.stats.govt.nz/
GEOGRAPHICAL AREA SERVED
Consultants: 3 part-timeFellow: 1 full-timeRegistrar: 1 full-timeCNS: 1 full-timeRN research: 1 part-timeDietician: 1 part-time
One of our CVID patients receiving IVIG replacement therapy
The Day Ward
PATIENTS ON Ig REPLACEMENT
CVID (37)
BRUTONS (2)
GOODSSYNDROME (1)HYPER IgM (1)
HYPER IgE (1)
CHURG-STRAUSS (1)IgG SUBCLASSDEF (1)
INTRAGAM®P (Human immunoglobulin)
• Pooled plasma donated by NZ blood donors (Unique to NZ; plasma from other countries is not used to make the NZ product)
• Sent to CSL Bioplasma in Australia for processing and returned to NZ
• Resulting product is a sterile preservative free solution; 90% IgG, trace of IgA and IgM.
• Licensed in NZ as replacement therapy in PID & certain disease conditions e.g. Guillain-Barre syndrome, ITP.
IMMUNOGLOBULIN REPLACEMENT THERAPY
Calculated at 400mg/kg body weight 74% intravenous IgG (IVIG) 3-4 weekly
infused through peripheral vein via electronic infusion pump
no after hour service work time lost stigma – visible evidence – impact choice of venous
access
21% home subcutaneous infusions (SCIG) Graseby syringe drivers CSL Bioplasma trial in progress
5% home IVIG infusions
Auckland DHB Quarterly Issues by Product by Speciality
233 237
211
243
220 225
261280
290
267 265276
267 272 273
252
287
349 354
375
323
284
326
348
50
100
150
200
250
300
350
400Ju
ly-S
ept 2
002
Oct
-Dec
200
2
Jan-
Mar
200
3
Apr
-Jun
e 20
03
July
-Sep
t 200
3
Oct
-Dec
200
3
Jan-
Mar
200
4
Apr
-Jun
e 20
04
July
-Sep
t 200
4
Oct
-Dec
200
4
Jan-
Mar
200
5
Apr
-Jun
e 20
05
July
-Sep
t 200
5
Oct
-Dec
200
5
Jan-
Mar
200
6
Apr
-Jun
e 20
06
July
-Sep
t 200
6
Oct
-Dec
200
6
Jan-
Mar
200
7
Apr
-Jun
e 20
07
July
-Sep
t 200
7
Oct
-Dec
200
7
Jan-
Mar
200
8
Apr
-Jun
e 20
08
Qua
ntity
(Uni
ts)
Intragam P (200ml eq.) - Immunology Linear (Intragam P (200ml eq.) - Immunology)
ADVERSE EVENTS
• Rare: – patient with anti-IgA antibodies; risk of haemolysis
• Often related to infusion rate: – infusions commenced at 60ml/hour, increased every 15 min by 60ml if
patient tolerant to a maximum rate of 240ml/hour
– those demonstrating side-effects rate not more than 150ml/hour
– premedication with antihistamine and paracetamol effective ( or NSAID)
• Observed events:– hypertension, back pain, rigor and headache
• Reported:– lethargy and mild backache 12 to 24 hrs post infusion
SUPPORT GROUPS
The Immune Deficiencies Foundation of New Zealand (member of IPOPI) www.idfnz.org.nz
ACKNOWLEDGMENTS
A sincere thank you to Dr Penny Fitzharris (Clinical Director) and Dr Miriam Hurst (Immunology Fellow).
REFERENCES/RESOURCES
• www.stats.govt.nz
• www.nzblood.co.nz
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