Supplementary Files
Keywords
Human immunoglobulin
Pregnancy
Abstract
Background: Common variable immunodeficiency is the most commonly-diagnosed primary immunodeficiency in adults; it is characterized by recurrent sinopulmonary and gastrointestinal infections, and increased incidence of malignancy and autoimmune processes. Many patients begin to have clinical manifestations during reproductive age.
Case report: A 34-year-old woman with 12 weeks of gestation who was diagnosed with common variable immunodeficiency after recurrent episodes of rhinosinusitis, pharyngoamygdalitis, and pneumonia. 0.6 g/kg of IVIG was prescribed every 21 days during the second trimester; the patient only presented one episode of pharyngoamygdalitis, with adequate response to treatment with antibiotics. During the third trimester the dose was adjusted to every 14 days. The patient ended the pregnancy at term without complications, with a child without defects and with proper weight and size.
Conclusions: The administration of immunoglobulin is the main treatment to control common variable immunodeficiency. While the recommended starting dose is 400-800 mg/kg intravenously every 3 to 4 weeks, there is no consensus on the dose to be used in pregnant women. The recommendation is to perform serum level controls before infusion to determine and adjust it.
References
Abolhassani H, Sagvand BT, Shokuhfar T, Mirminachi B, Rezaei N, Aghamohammadi A. A review on guidelines for management and treatment of common variable immunodeficiency. Expert Rev Clin Immunol. 2013;9(6):561-74. doi: 10.1586/eci.13.30.
UpToDate. [Sitio web]. Orange JS, Hossny EM, Weiler CR. Immune globulin therapy in primary immunodeficiency. [Consultado 2015 Sep 10]. Disponible en: http://www.uptodate.com/contents/immune-globulin-therapy-in-primary-immunodeficiency.
UpToDate. [Sitio web]. Bauer K. Hematologic changes in pregnancy. [Consultado 2015 Oct 3]. Disponible en: http://www.uptodate.com/contents/hematologic-changes-in-pregnancy.
UpToDate. [Sitio web]. Foley M. Maternal cardiovascular and hemodynamic adaptations to pregnancy. [Consultado 2015 Oct 3]. Disponible en: http://www.uptodate.com/contents/maternal-cardiovascular-and-hemodynamic-adaptations-to-pregnancy
Bernstein IM, Ziegler W, Badger GJ. Plasma volume expansion in early pregnancy. Obstet Gynecol. 2001;97(5 Pt 1):669-672.
UpToDate. [Sitio web]. Bonilla F. Secondary immunodeficiency due to underlying disease states, environmental exposures, and miscellaneous causes. [Consultado 2015 Oct 3]. Disponible en: http://www.uptodate.com/contents/secondary-immunodeficiency-due-to-underlying-disease-states-environmental-exposures-and-miscellaneous-causes
Matthiesen L, Berg G, Ernerudh J, Håkansson L. Lymphocyte subsets and mitogen stimulation of blood lymphocytes in normal pregnancy. Am J Reprod Immunol. 1996;35(2):70-79.
Shalev E, Ben-Ami M, Peleg D. Common variable hypogammaglobulinemia in pregnancy. Br J Obstet Gynaecol. 1993;100(12):1138-1140. doi: 10.1007/s10875-014-0123-3.
Gundlapalli AV, Scalchunes C, Boyle M, Hill HR. Fertility, pregnancies and outcomes reported by females with common variable immune deficiency and hypogammaglobulinemia: results from an internet-based survey. J Clin Immunol. 2015;35(2):125-134. doi: 10.1007/s10875-014-0123-3.
Kralickova P, Kurecova B, Andrys C, Krcmova I, Jilek D, Vlkova M, et al. Pregnancy outcome in patients with Common Variable Immunodeficiency. J Clin Immunol. 2015;35(6):531-537. doi: 10.1007/s10875-015-0188-7.
Danieli MG, Moretti R, Pettinari L, Gambini S. Management of a pregnant woman with common variable immunodeficiency and previous reactions to intravenous IgG administration. BMJ Case Rep. 2012;2012. doi: 10.1136/bcr-2012-007594.
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