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How to administer Subcutaneous Immunoglobulin (Hizentra)- Quick Guide

Presentation

2g (10mL) or 4g (20mL) bottles
Hizentra^® is a 20% (20g/100mL) solution of human immunoglobulin (antibodies) prepared from pooled plasma donations made from American and European donors for subcutaneous use only.
For intravenous immunoglobulin Intragam^®P or Privigen pages.
For intramuscular immunoglobulin, please see Normal Immunoglobulin.
Hizentra replaces Evogam. Please contact an NZBS TMS to discuss Hizentra^®, if needed.

Prescription

Because Evogam® is an expensive medication with increasing demand, pre-approval of new patients receiving Evogam® is required. Please see the guidelines provided on the right and contact your local Blood Bank to see how pre-approval is managed locally. An example of a pre-approval form is provided, also on the right.

ABO Compatibility

Compatibility is not relevant for manufactured (fractionated) plasma product transfusion.

Storage and Infusion

Hizentra^® should be stored in a refrigerator (2-8°C). Do not freeze. Once removed from the refrigerator, store Hizentra^® below 25°C and use within 2 weeks.
Use a standard infusion set. A filter is not needed.
If not used, please return to Blood Bank
See the Health Care Professionals' Information Brochure for instructions on spiking the bottle.
Prime the infusion tubing, clean the injection site and insert the needle at a 45° angle into the fatty tissue just below the skin's surface.
Suitable injection sites include lower abdomen, thighs, upper arms and hips. More than one injection site may be needed per infusion, especially if the volume prescribed exceeds 20mL (3.2g).

Precautions

Acute renal failure: In patients at risk for acute renal failure, Hizentra should be administered subcutaneously at the minimum rate of infusion and dose practicable.
Passive Transfer of Antibodies and Interference with Serological Testing: After injection of immunoglobulin, the transitory rise of the various passively transferred antibodies in the patient's blood may result in misleading positive results in serological testing.
Read manufacturer's instructions carefully
Always observe for turbidity, floating material and sediment

Vaccination

Inactivated vaccines (e.g. flu, hepatitis B, tetanus, pneumococcal): Inactivated vaccines may be administered concurrently with passive antibody to induce active immunity.
Live attenuated virus vaccines (e.g. meales, mumps, polio, rubella): Passively acquired antibody can interfere with the response to live, attenuated virus vaccines. Administration of such vaccines should be deferred until approximately three months after passive immunisation. If immunoglobulin is administered within two weeks of vaccination with a live attenuated virus vaccine, the efficacy of the vaccine may be compromised. Consideration should be given to re-vaccination approximately three months (one year for measles) after the immunoglobulin was given.

Rate

Each bottle should be infused within 4 hours of spiking
Adult and Paediatric patients:The recommended infusion rate depends on the individual patient’s needs.
If well-tolerated, the infusion rate can then gradually be increased to 35 mL/hour/site for the subsequent two infusions.
Thereafter, the infusion rate can be further increased as per patient’s individual tolerability.

Monitoring

Recipients should remain under observation for 20 minutes following administration in case they experience an immediate adverse event requiring treatment.

DO NOT

DO NOT add medications to blood products.
DO NOT give intravenously. If Hizentra^® is inadvertently administered into a blood vessel, patients could develop shock.

Dose

Replacement therapy (for immunodeficiency): adjusted for the individual patient. Typically 0.05 - 0.15 grams Hizentra^® per kg bodyweight per week. This corresponds to a monthly dose in the range of 0.2-0.6g/kg. This should be adjusted based on IgG trough levels.

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