Order from Virology: NB: They need to made aware of expecting mother who is Hep B +ve and if so will pre-order.
Other indications please order direct from Colindale.

Renal Transplant including ATG guidance

• Drug chart template BASILIXIMAB STANDARD RISK renal transplant recipient 2015 v1.1.pdf
• Renal transplant management of acute rejection guidelines v1.0.pdf
• Renal transplant immunosuppression protocol 2015 v1.1.pdf

For the full process, please refer to the Immunoglobulin Use (IG) Guideline (14).pdf and the Immunoglobulin approval process flow chart under ‘attached files’

Please e-mail bartshealth.ivigpharmacyteam@nhs.net for queries about commissioning position, meeting dates or general advice.

Summary of prescribing and approval process:

E-referrals must be submitted for ALL immunoglobulin prescriptions on the immunoglobulin database (e-referral platform) https://nww.mdsas.nhs.uk/IgD/

Please note e-referrals can now be submitted without the need for account log in.

Referrals cannot be accepted via email. Missing information may lead to a delay in processing the application. Please ensure a multidisciplinary discussion has taken place prior to the application and is evidenced in the application accordingly.

Follow the steps below to establish the approval status for the intended immunoglobulin therapy (see also the immunoglobulin approval process flow chart in the ‘attached files’):

1. Local list of indications for sub-regional use, also known as Emergency or Red List – see section 2.5 in the Immunoglobulin Use (IG) Guideline - Immunoglobulins-Local list of indications for sub-regional use v0.6 FINAL (4).pdf (see link below in attached files) If the indication is on this list, the first dose is automatically approved (does not require prior panel approval). Submit the e-referral request and proceed with the treatment. If the indication is not on the Emergency list, please move on to point 2                  
2. NHS England Clinical Commissioning Policy (CCP 2024) - Clinical Commissioning Policy for the use of therapeutic immunoglobulin (Ig) England (2024) Using this document establish if prior panel approval is required for the intended indication and length of therapy.
   1. If prior panel approval is required, submit an e-referral request, and liaise with your pharmacist and the immunoglobulin pharmacy team to escalate for panel review. Await response via email.
   2. If prior panel approval is not required, submit an e-referral request, and proceed with the treatment.                       
   3. If the indication is not listed in the Emergency List or the CCP 2024, please move on to point 3.
3. Indications not listed in the Emergency List or the Clinical Commissioning Policy2024, are not routinely commissioned. Submit an e-referral request stating the correct indication. Seek panel review before dosing. IFR application may be sent to NHSE for funding. Treatment before funding decision by NHSE has been reached is at financial risk to the division. The General Manager or Divisional Director for the respective division must agree for funding to be provided internally. Liaise with your pharmacist and the immunoglobulin pharmacy team for further information and advice at ivigpharmacyteam@nhs.net.
4. Liaise with your pharmacist and the immunoglobulin pharmacy team for further information and advice at ivigpharmacyteam@nhs.net.

As specified in the Immunoglobulin Process Map (see Immunoglobulin Use Guideline)

• Urgent (< 24 hours)– should be included in the ‘Local list of indications for sub-regional use’ (Emergency/red list). Submit an e-referral request and proceed with the first treatment dose.
• Urgent (24 – 48 hours)– not included in the ‘Local list of indications for sub-regional use’ (Emergency/red list). Submit an e-referral request. Proceed with the treatment if prior panel approval is not required. If prior panel approval is required, liaise with your pharmacist and the immunoglobulin pharmacy team to escalate to the virtual panel for a decision and await panel decision by email before dosing.
• Not urgent(can wait until next monthly panel meeting) – submit an e-referral request. Liaise with your pharmacist and the immunoglobulin pharmacy team. Await communication from the immunoglobulin pharmacy team via email to arrange case presentation at panel meeting and await final panel decision before dosing.

Dosing

NHS England Clinical Commissioning Policy (CCP 2024) recommends using the Ideal Body Weight (IBW) in adults and children.

• Calculate the total treatment course and round down to the nearest dose which can be administered using whole vials.
• Note in adult patients’ part vials should never be used. Where the dose is split over multiple days, daily dose may defer

Adult dose (>18 years) – Follow the steps below to calculate the Ideal Body Weight (IBW)- use this to determine the immunoglobulin dose:

1. Calculate Ideal Body Weight (IBW kg):

Males = 50 + (0.91 x [Height (cm) -152.4])

Females = 45.5 + (0.91 x [Height (cm) -152.4])

Note: If IBW is greater than the Actual Body Weight (ABW)- use ABW for dosing

*For Pregnant Patients IBW should be based on Booking weight

Paediatric dose (0 -18 years) – Dosing should be based on the Ideal Body Weight (IBW).

Use the growth charts below to determine the Ideal Body Weight (IBW), and then use this weight to determine the immunoglobulin dose:

1. Measure height/length of child (cm)
2. Identify height centile for their age using RCPCH growth charts UK-WHO growth charts 0 – 4 years and 2-18 years and select the appropriate gender
3. IBW = weight at same centile as height for patient’s age

0 – 4 years: RCPCH-WHO baby growth charts for 0-4 years

2 – 18 years: UK-WHO growth charts - 2-18 years | RCPCH

*In children whose ABW is significantly lower than their IBW (>30% difference), senior advice should be sought regarding appropriate dosing weight

Round down the dose to the nearest 5g WHERE POSSIBLE, within 10%. For small doses (for instance in neonates), round the dose to the nearest measurable dose.

See How should medicines be dosed in children who are obese? – SPS - Specialist Pharmacy Service – The first stop for professional medicines advice

Neonates:

Actual Body Weight (or birth weight where this is higher) should be used – except where the patient is fluid overloaded and a clinically determined “working weight” should be used for dosing

IVIG for ITP:

Please refer to Immunoglobulin Use (IG) Guideline for Immune Thrombocytopaenia (ITP) – short term use immunoglobulin under ‘attached files’

IVIG for paediatric patients prescribed IG with input from Great Ormond Street Hospital

Please refer to - Approvals process for patients prescribed human immunoglobulin with input from Great Ormond Street Hospital under ‘attached files’

• Immunoglobulin Use (IG) Guideline (10).pdf
• Immunoglobulin E-referral step by step guide FINAL v1.1 17032022 (6).pdf
• Immunoglobulin Use (IG) Guideline for Immune Thrombocytopaenia (ITP) – short term use immunoglobulin.pdf
• IVIg ordering sheet - to print direct Sept 2017 (1).pdf
• Approvals process for patients prescribed human immunoglobulin with input from Great Ormond Street Hospita (1).pdf
• Pharmacy IG Process Map - 14_May_2024.pdf
• Local list (Emergency List) of indications for sub-regional use of Immunoglobulins.pdf
• NHSE CCP for the use of therapeutic Immunoglobulin (Ig) April 2024 v2.0.pdf

Hospital only

FOR HOSPITAL USE ONLY

FOR HOSPITAL USE ONLY

Available from Colindale laboratories on a case by case basis

• BCG public health england letter to pharmacists 160816.pdf

Please see microguide for the splenectomy guideline on non surgical prophylaxis.

Please see microguide for the splenectomy guideline on non surgical prophylaxis.