A healthy immune system makes normal antibodies that help protect the body against invading viruses, bacteria, and toxins. But if you have autoimmune hemolytic anemia (AIHA) — your immune system makes autoantibodies, rogue proteins that attack your own red blood cells — you might be given antibodies in the form of intravenous immunoglobulin (IVIG). Also known as intravenous immune globulin, IVIG can even be used to help treat severe AIHA symptoms.

Read on to learn more about IVIG and why your hematologist (blood specialist) might recommend this treatment. We’ll also go over the benefits, drawbacks, and potential side effects of IVIG therapy.

What Is Intravenous Immunoglobulin Therapy?

The scientific term for “antibody” is “immunoglobulin” (Ig). The immune system makes five types of immunoglobulins to protect the body from pathogens and microbes that cause sickness. The most common type is IgG, which is also the most abundant. IVIG also contains small amounts of IgM (the first antibody made during an initial infection) and IgA (found in the digestive and respiratory tracts.)

IVIG therapy uses concentrated antibodies collected from the blood of thousands of healthy donors. You may be concerned that if any of the donors had an infectious disease, IVIG treatment could make you sick. However, all donations are screened for any bacteria and viruses and are treated so you won’t get an infection.

When given with other treatments during severe AIHA attacks, IVIG can help red blood cells live longer, reducing the need for blood transfusions.

How Does Intravenous Immunoglobulin Therapy Work?

Doctors and researchers aren’t quite sure why IVIG works to treat autoimmune conditions, but one theory involves a protein known as the neonatal Fc receptor (FcRn). This protein allows the immune system to control how many antibodies are made. It’s also present in IVIG. Adding extra FcRn into the bloodstream may encourage the body to get rid of extra antibodies, including autoantibodies causing AIHA.

New drugs being developed use synthetic antibodies and antibody fragments to control the Fc receptor and reduce levels of autoantibodies.

When Is Intravenous Immunoglobulin Therapy Used?

There are two types of AIHA — warm and cold. IVIG is usually reserved as an adjunct treatment (used with other treatments) for warm AIHA to help quickly raise red blood cell levels and relieve severe symptoms. It’s not used as often to treat cold AIHA.

If AIHA is left untreated, it can become life-threatening. People who have rapid or extremely severe hemolysis (destruction of red blood cells) may become dependent on blood transfusions. High-dose IVIG is typically given along with a corticosteroid, such as prednisone or methylprednisolone, to help control inflammation.

If hemolysis continues to be difficult to control, your hematologist may recommend other treatment options for AIHA, including:

• Splenectomy (surgery to remove the spleen)
• Rituximab (Rituxan), a biologic drug made of a synthetic antibody that blocks immune cells known as B cells from making autoantibodies
• Immunosuppressive drugs, which keep the immune system from making autoantibodies

Other Uses for Intravenous Immunoglobulin

Not many studies have looked into using IVIG to treat AIHA, but this therapy is widely used for other autoimmune diseases and inflammatory conditions. Many of these conditions are also caused by autoantibodies attacking healthy cells and tissues.

Examples of other conditions treated with IVIG include:

• Immune thrombocytopenia, in which platelets (cell fragments that help blood clot) are destroyed
• Systemic lupus erythematosus
• Kawasaki disease
• Chronic inflammatory demyelinating polyneuropathy
• Guillain-Barré syndrome
• Myasthenia gravis

How Is Intravenous Immunoglobulin Treatment Given?

IVIG treatment is typically done at a hospital or an infusion center over the course of a few hours. When you arrive, a health care provider will locate a vein in your arm and insert a small, thin, flexible tube known as an IV catheter. The catheter delivers the IVIG along with fluids, if needed.

Your treatment schedule will depend on how severe your symptoms are. Your doctor or hematologist may use one or two large doses of IVIG to start. You may also receive a lower dose over the course of several days. During treatment, you’ll be monitored for any side effects.

What Are the Pros and Cons of Intravenous Immunoglobulin Therapy?

All treatments come with their own set of benefits and risks, which may vary from person to person. Your hematologist will weigh these factors when it comes to your treatment plan.

One of the main benefits of IVIG is that it begins working in one to five days to treat AIHA. On the other hand, medications like prednisone, rituximab, and immunosuppressants can take several days or even weeks to improve symptoms. This is why IVIG is the preferred emergency treatment for people with severe hemolysis.

However, the effects of IVIG are short-lived, lasting only around three weeks. You may need to go back for another infusion if you don’t respond well to other AIHA treatments or can’t take them. Another downside of IVIG therapy is the need to go to the hospital or infusion center — it can’t be done at home because it isn’t as simple as taking a pill or giving yourself an injection.

There’s also a chance that IVIG therapy won’t work for you. Studies show that around 30 percent to 40 percent of people with AIHA respond to IVIG treatment. You may need additional emergency treatment such as plasma exchange to help treat your AIHA symptoms.

Another downside is that the extra antibodies from IVIG can prevent vaccines from working well at first. Talk to your doctor about when it’s best to receive vaccinations after your infusions. You may need to time them carefully.

Potential Side Effects of Intravenous Immunoglobulin Therapy

IVIG treatment is generally safe, and most people have few side effects. There is the potential to react to IVIG infusions if you’re receiving larger doses or haven’t had infusions that often — your body may not have had time to adjust to the treatment. Overall, around 25 percent of people receiving IVIG therapy experience side effects.

The most commonly reported side effect is a headache. Flu-like symptoms are also common and can include:

• Fever
• Flushing
• Chills
• Fatigue
• Achy or painful joints and muscles
• Rashes
• Nausea
• Vomiting

If you experience these side effects during an IVIG infusion, your doctor can make some adjustments so you’re more comfortable. Before your infusion, they may give you nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) or medications like acetaminophen (Tylenol) to relieve aches and pains and reduce fever.

Your doctor may also give your IVIG more slowly or split bigger doses into several ones given over the course of a few days. This helps your body adjust to the treatment and can lower the risk of side effects.

Hydration is important during IVIG treatment, so be sure to drink plenty of water before an infusion. Your doctor may also give you extra fluid in your IV to help keep you hydrated.

Talk With Others Who Understand

On myAIHAteam, the social network for people with hemolytic anemia and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with hemolytic anemia.

Have you received intravenous immunoglobulin therapy to treat your autoimmune hemolytic anemia? Do you take any steps to reduce side effects of IVIG infusions? Share your experience in the comments below, or start a conversation by posting on your Activities page.