Improving utilization of intravenous immune globulin through concurrent use of an indication form.

OBJECTIVE: Based on the guidelines of the United States Joint Commission for Accreditation of Health Care Organizations for conducting a drug utilization evaluation, we evaluated the usage of intravenous immune globulin at our tertiary care hospital. METHODS: An initial concurrent evaluation of IVIG use showed deficiencies in both dosing and compliance with hospital policy, with regards to its use for unlabeled indications. Two follow-up evaluations were performed after the institution of an IVIG indication form, which was designed to accompany each order. RESULTS: We demonstrated consistent improvements in both dosing criteria, labeled IVIG use, and compliance with hospital policy its use in unlabeled indications. An ongoing prospective program targeting IVIG use, combined with the introduction of a simple indication form improved its utilization at our hospital.

Treatment of cyclophosphamide-induced intractable hemorrhagic cystitis.

We report the successful use of prostaglandin F2 alpha continous bladder irrigation in two patients for the treatment of intractable cyclophosphamide-induced hemorrhagic cystitis which was resistant to conventional therapy in two patients. A 0.7 mg% solution of prostaglandin F2 alpha was used for continuous bladder irrigation at a rate of 150 to 200 cc/hr for four days. The response was complete in both patients and no side effects were noted.

Successful management of Ph chromosome chronic myelogenous leukemia with leukapheresis during pregnancy.

We report the successful management of a 25 year-old woman diagnosed in the second trimester of her pregnancy with chronic myelogenous leukemia (CML). She was treated with leukapheresis until her delivery at 38 weeks of gestation. The procedure was without significant adverse effects on the patient or the fetus. Following induced vaginal delivery, the patient underwent allogeneic bone marrow transplantation from her HLA-matched brother and is presently disease free 13 months following her transplant.