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Clinical Guidelines for Immunoglobulin Use Welcome

Clinical Guidelines for Immunoglobulin Use Welcome. Denise O’Shaughnessy. Clinical Guidelines for Immunoglobulin Use Overview of changes. Aidan McManus. OUTLINE Where are the guidelines? Major changes to guidelines Minor changes to guidelines. Where are the guidelines?.

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Clinical Guidelines for Immunoglobulin Use Welcome

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  1. Clinical Guidelines for Immunoglobulin UseWelcome Denise O’Shaughnessy

  2. Clinical Guidelines for Immunoglobulin UseOverview of changes Aidan McManus

  3. OUTLINE • Where are the guidelines? • Major changes to guidelines • Minor changes to guidelines

  4. Where are the guidelines?

  5. Where are the guidelines? www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_129617 DH_129617

  6. Audio slide presentations online www.ivig.nhs.uk

  7. Second edition update 2008 2011

  8. Second edition update 2008 2011

  9. Second edition updateMajor changes Selection criteria for appropriate use of immunoglobulin Efficacy outcomes to assess treatment success Modification of existing indications and inclusion of new indications

  10. Haemophagocytic lymphohistiocytosis – 2008

  11. Total Grams Infused for Haematology Q1 2010

  12. Australian guideline

  13. Haemophagocytic lymphohistiocytosis – 2011

  14. Second edition update Selection criteria for appropriate use of immunoglobulin Efficacy outcomes to assess treatment success Modification of existing indications and inclusion of new indications

  15. Australian guideline

  16. Haemophagocytic lymphohistiocytosis – 2011

  17. Australian guideline

  18. Efficacy monitoring “The update specifies the outcome(s) measures, but not the degree in improvement of outcome(s) required to constitute treatment success” Commissioners will work with expert clinicians to refine these outcomes to provide defined ‘treatment success’ measures where possible.

  19. Second edition update Selection criteria for appropriate use of immunoglobulin Efficacy outcomes to assess treatment success Modification of existing indications and inclusion of new indications

  20. Immunoglobulin use in haematology 2010 database report

  21. Grouping of diseases under single headings

  22. Changes to the colour-coded prioritisation in the Demand Management Programme Grey to Blue The database review identified two of the top 10 immunoglobulin-using indications as Grey (secondary antibody deficiencies and antibody-mediated rejection following solid organ transplantation). In the previous edition, they were listed under immunosuppressive pharmacotherapy, and separately under some of the haematological malignancies such as CLL, without listing other mature B-cell malignancies such as non-Hodgkin’s lymphoma. These have been revised into a single indication. Antibody-mediated rejection following solid organ transplantation andantibody-incompatible transplantation were reviewed, and a single grouping of ‘Transplantation (solid organ)’ has been introduced and listed as Blue.

  23. Changes to the colour-coded prioritisation in the Demand Management Programme Grey to Blue Acquired von Willebrand disease has now been included with acquired haemophilia, in the general disease grouping of ‘Coagulation factor inhibitors’. Polymyositis and Inclusion body myositis havenow been grouped with dermatomyositis under the general disease grouping of inflammatory myopathies, with strict selection criteria. Post-transfusion hyperhaemolysis has now been grouped under the more general heading of haemolytic anaemia. SLE with secondary immunocytopenias shouldbe considered under the relevant immune cytopenia.

  24. Changes to the colour-coded prioritisation in the Demand Management Programme Blue to Red Specific antibody deficiency, as a recognised primary antibody deficiency disorder, has been reclassified as a Red indication (for those cases where immunoglobulin replacement therapy is required). Haemolytic disease of the newborn has beenupdated to reflect recommendations in ‘NICE clinical guideline 98’ on neonatal jaundice.

  25. Second edition updateMinor changes Definitions of duration of immunoglobulin treatment Recommended dosing of immunoglobulin Ideal body weight-adjusted dosing of immunoglobulin

  26. Definitions of duration of immunoglobulin treatment

  27. Recommended dosing of immunoglobulin

  28. Ideal body weight-adjusted dosing of immunoglobulin

  29. Database update will reflect advice and updated terminology

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