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122 Plasma KCE Reports 120 APPENDIX 4: IMMUNO-HAEMATOLOGICAL SURVEY Use of immunoglobulins in the treatment of immune deficiencies and other diseases This information is asked by the KCE to project the future needs in immunoglobulins (IG) in Belgium. This work has been requested by INAMI/RIZIV to prevent future IG shortages. Your data will not be distributed to any other institution, and will not be used to assess appropriateness of IG use in Belgian centers. If you have any question about this survey or the project, you can contact: Dr Germaine Hanquet, KCE, 02/287.33.37, germaine.hanquet@kce.fgov.be Or Dr Michel Huybrechts, KCE, 02/287.33.42, michel.huybrechts@kce.fgov.be Thank you for your assistance! Name of the physician:…………………………………………………………………. Name of the Centre / Hospital:………………………………………………………… In the first column (total patients followed), please include all patients that were seen in your centre in 2008, regardless of treatment. 1. For Primary Immune Deficiencies (PID) treated in your centre in 2008 If this information is not available for 2008, please provide data from other periods and specify. Treatment with intravenous immunoglobulins Indications Total number patients Number of IG Average dose per followed in your perfusions perfusion in g/kg centre administered in 2008 (or usual dose) PID in adults PID in children Comments:………………………………………………………………………………. Treatment with subcutaneous immunoglobulins Indications Total number patients Number of IG Average dose per followed in your perfusions prescribed perfusion in g/kg centre in 2008 (or usual dose) PID in adults PID in children Comments:……………………………………………………………………………….
KCE Reports 120 Plasma 123 For other immune deficiencies treated in your centre in 2008 with intravenous IG Indications Total number patients followed Myeloma Chronic lymphocytic leukemia Prevention of infections in transplant Other immune deficiencies that required IG (please specify) Number IVIG treatments given in 2008 Average dose per treatment in g/kg (or usual dose) Comments:………………………………………………………………………………….. 4. For other indications treated in your centre in 2008 with intravenous IG Indications Number IVIG treatments given in 2008 Idiopathic thrombocytopenic purpura in children Idiopathic thrombocytopenic purpura in adults Guillain Barré syndrome Kawasaki syndrome Toxic shock syndrome Infections in neonates Others:……………… General comments: Do you wish to receive the KCE report once published? (it will also available be available on our website www.kce.fgov.be) Thank you for your time! Average dose per treatment in g/kg (or usual dose)
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KCE Reports 120B Plasma i PRÉFACE
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KCE Reports 120B Plasma iii MÉTHOD
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KCE Reports 120B Plasma v En ce qui
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KCE Reports 120B Plasma vii RECOMMA
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KCE Reports 120 Plasma 3 GLOSSARY A
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KCE Reports 120 Plasma 29 2.2 TRANS
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