1. AUCKLAND CITY HOSPITAL AUCKLAND
IMMUNOLOGY NURSING AT
AUCKLAND CITY HOSPITAL AUCKLAND
NEW ZEALAND - AOTEAROA
SANCHIA VOS
CLINICAL NURSE SPECIALIST

5. 21 DISTRICT HEALTH BOARDS Population of 4. 2 million-http://www. stats
Population of only 4.2 million whose health needs are managed by 21 district health boards, making it a difficult task to calculate the number of patients with PID.

6. GEOGRAPHICAL AREA SERVED
Consultants: 3 part-time
Fellow: full-time
Registrar: full-time
CNS: full-time
RN research: 1 part-time
Dietician: 1 part-time
North Island more heavily populated with + 3million people, over 1 million reside in Auckland.

7. The Day Ward
One of our CVID patients receiving IVIG replacement therapy

8. PATIENTS ON Ig REPLACEMENT
Out of our total patient population of 45 with PID, 37 have CVID.(82%) the remaining 18% include patients with Brutons, Goods syndrome, Churg-strauss, Hyper IgE and IgG Subclass deficiency.
Our patients are mainly female (67%) with a predominant age group of 30 – 40 years.

9. INTRAGAM®P (Human immunoglobulin)
Pooled plasma donated by NZ blood donors (Unique to NZ; plasma from other countries is not used to make the NZ product)
Sent to CSL Bioplasma in Australia for processing and returned to NZ
Resulting product is a sterile preservative free solution; 90% IgG, trace of IgA and IgM.
Licensed in NZ as replacement therapy in PID & certain disease conditions e.g. Guillain-Barre syndrome, ITP.

10. IMMUNOGLOBULIN REPLACEMENT THERAPY
Calculated at 400mg/kg body weight
74% intravenous IgG (IVIG) 3-4 weekly
infused through peripheral vein via electronic infusion pump
no after hour service
work time lost
stigma – visible evidence – impact choice of venous access
21% home subcutaneous infusions (SCIG)
Graseby syringe drivers
CSL Bioplasma trial in progress
5% home IVIG infusions
Intravenous Infusions are given via venous access using a peripheral vein via an electronic infusion pump. No after hour service. Patients loose time off from work, do not want visible evidence of venous access.

12. ADVERSE EVENTS Rare: Often related to infusion rate: Observed events:
patient with anti-IgA antibodies; risk of haemolysis
Often related to infusion rate:
infusions commenced at 60ml/hour, increased every 15 min by 60ml if patient tolerant to a maximum rate of 240ml/hour
those demonstrating side-effects rate not more than 150ml/hour
premedication with antihistamine and paracetamol effective ( or NSAID)
Observed events:
hypertension, back pain, rigor and headache
Reported:
lethargy and mild backache 12 to 24 hrs post infusion
Patients tend to take a mild analgesic e.g. paracetamol and an anti-histamine prior to their infusion.

13. SUPPORT GROUPS
The Immune Deficiencies Foundation of New Zealand (member of IPOPI)

14. ACKNOWLEDGMENTS
A sincere thank you to Dr Penny Fitzharris (Clinical Director) and Dr Miriam Hurst (Immunology Fellow).

15. REFERENCES/RESOURCES