Karen Topping discusses the complexities of immunoglobulin usage and how current demand cannot be met
Human normal immunoglobulin (Ig) is currently available in the UK from eight different manufacturers in both subcutaneous and intravenous forms. NHS England commissions Ig usage based on the Department of Health’s 2008 guidelines.1
A colour-coded prioritisation scheme is in place, which ensures that patients with the most severe, life-threatening conditions receive Ig as a priority. The guidelines suggest a variety of dosage regimens for patients, and treatment may be acute or long term.
Around 16,000 patients are treated with Ig annually.2 Neurological conditions use the most Ig by volume (44%), immunology uses 32%, and haematology uses 9%. Other specialities that use Ig include paediatrics, transplant, dermatology, intensive care, infectious diseases, and obstetrics. The most common indication for Ig usage is primary immunodeficiency disease, followed by secondary antibody deficiency, and thirdly, immune thrombocytopenia.2 See Box 1 for further information on Ig therapy.
Managing the governance around Ig within NHS trusts is a complex task, particularly because unlike