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FAQs in Aplastic Anemia


What is Thymogam?

Thymogam is a biological product. It is a sterile solution of Polyclonal antibodies primarily containing IgG type of antibodies, it is obtained from Horses hyperimmunized with Human Thymocytes. Hence it is called Antithymocyte Globuline (ATG)

It is used in patients with moderate or severe Aplastic anemia who are not eligible for Bone marrow transplant. It is to be given Intravenously over a period of 4-5 hrs for 4 to 5 days by a Healthcare professional (can vary with Hospital protocol). Patient will be required to hospitalize for minimum 4-5 days while receiving Thymogam treatment.

How is Thymogam thought to work in Aplastic Anemia ?

Thymogam is an Immunosuppressant drug (it will suppress immunity). In Aplastic Anemia, patient's Bone marrow doesn't make enough Red blood cells (RBCs), White Blood Cells (WBCs) and Platelets. It is because in Aplastic anemia patient, T-lymphocytes in patient's body attacks Bone marrow causing its inability to make these cells. Thymogam suppresses action of T-lymphocytes on Bone marrow causing to produce RBCs, WBCs and Platelets and return to normal level.

How many vials of Thymogam do I need if I am prescribed with dose of 40 mg/kg/day?

Thymogam is usually given at a dose of 40 mg/kg/day for 4-5 days. Hence, total required dose varies with the patient's body weight.

e.g. If your weight is 50 Kg then your dose will be 2000 mg/day. Thymogam is available at strength of 250 mg, hence you will require 8 vials of Thymogam 250 mg per day.

What are the serious adverse reactions associated with Thymogam?

Frequently reported adverse reactions among patients enrolled in aplastic anaemia studies were

  1. Fever, chills, skin rashes, arthralgia and thrombocytopenia.
  2. Abnormal tests of liver function (SGOT, SGPT, alkaline phosphatase) and renal function (serum creatinine)
  3. Serum sickness: this happens when immune system reacts to foreign proteins in the medicine. It causes fever, rash, joint pain, and muscle aches
  4. Less frequently reported reactions: Headache, nausea, vomiting, diarrhoea, dyspnoea, hypotension, night sweats, stomatitis, chest pain, back pain, pain at the infusion site and peripheral thrombophlebitis.
  5. Rarely reported reactions: periorbital oedema, agitation, dizziness, weakness or faintness, malaise, epigastric pain or hiccoughs, laryngospasm, paraesthesia, lymphadenopathy, infection, possible encephalitis, herpes simplex reactivation, wound dehiscence, hyperglycaemia, hypertension, oedema, pulmonary oedema, pleural effusions, tachycardia, seizure, anaphylaxis, iliac vein obstruction, renal artery thrombosis, proteinuria and toxic epidermal necrosis.

What are the most common side effects I may experience with Thymogam?

  1. Fever
  2. Chills
  3. Urticaria (Skin rash)

These side effects may go away after treatment with Thymogam.

How do I know if I am allergic to Thymogam?

Physicians can recommend skin testing before commencing treatment with Thymogam.

  1. A conservative, conventional approach would first employ epicutaneous (prick) testing with undiluted Thymogam. If the patient does not show a wheal ten minutes after pricking, then proceed to step 2.
  2. Intradermal testing with 0.02mL of a 1:1000 dilution of Thymogam in Sodium chloride injection with a separate Sodium chloride injection control of similar volume. Observe the results every 10 minutes over the first hour after intradermal injection. A wheal of 3mm or greater in diameter at the site of Thymogam injection than that at the Sodium chloride injection control site (or a positive prick test) shows clinical sensitivity and an increased possibility of systemic allergic reactions.

Note :

The predictive value of this test has not been proved clinically. Allergic reactions such as anaphylaxis have occurred in patients whose skin test is negative.

When shall I call doctor while receiving Thymogam infusion?

You should call your doctor if you experience Severe anaphylactic reaction (hyper allergic reaction), susceptibility to get allergic reaction can be predicted with Skin test as mentioned above.

Your doctor/nurse should also watch out for Thrombocytopenia (Fall in platelet count)/Leucopenia (Fall in WBC count) after infusion.

What can I do if I experience fall in blood count while receiving Thymogam?

You should call doctor for consultation. You may receive Blood transfusion after consulting with doctor.

Where can I get Thymogam?

You can get Thymogam injection from the Hospital Pharmacies. It is available at all major hospital pharmacies which are supplied through authorized distributors for Bharat Serums and Vaccines Limited.

For more information regarding availability, please see our section Contact Us.

Are there any clinical trial available for patients with Aplastic Anemia?

There are trials conducted for Thymogam at single center (Single hospital) and muticenter (Multiple hospital) on patients with Aplastic Anemia in India.

What should I do if I am taking Thymogam or am prescribed other medicines or supplements while taking Thymogam?

It is important to tell your doctor about all medicines or herbal/ayurvedic/unani medicines that you are taking.

Do not start taking any new medicines or herbal/ayurvedic/unani medicines before talking with your doctor.