[PAGID] IVIG potential benefit?

[Sorensen, Ricardo]

The problem with discussing IgG replacement in this patient is that the
present clinical status is not defined. How often is the patient sick?
How many days of work that she miss due to infections? How often does
she require antibiotics? Are antibiotics effective. What is her quality
of life, etc. 

 

The only antibody abnormality seems to be a persistent, mildly decreased
IgM. This may signal a dysfunctional antibody production. But this would
be irrelevant if there are no documented recurrent infections.

 

Ricardo U Sorensen, MD

LSU Health Science Center and Children's Hospital,

New Orleans

________________________________

From: pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Charlotte
Cunningham-Rundles
Sent: Monday, August 07, 2006 4:59 PM
To: pagid at list.clinimmsoc.org
Subject: Re: [PAGID] IVIG potential benefit?

 

these titers sound basically normal to me also, so I'd think not as
well.

 

Charlotte Cunningham-Rundles MD PhD
Professor of Medicine, Pediatrics  and Immunobiology
Mount Sinai School of Medicine
1425 Madison Ave, New York 10029
phone 212 659 9268
fax  212 987 5593

Email:  charlotte.cunningham-rundles at mssm.edu

 

 

	I have a new 36yo female patient with lupus, recurrent otitis,
and s/p a single episode of pneumonia.  The pneumonia occurred 18 months
ago after an episode of pleurisy, and was complicated by an empyema
requiring surgery, chest tubes, and a prolonged hospital stay.  s/p left
tympanoplasty x 2 as child and adult.  No sinus disease ever.  Immune
studies reveal normal IgG (950-1200), normal IgA (260-315), and a low
IgM (17 after Rituxan - 31 before Rituxan).  First set of pneumococcal
titers were drawn 1 year after a Pneumovax, and revealed IgG Ab levels
>3.5 ug/mL in 9 of the 14 serotypes.  Repeat pneumococcal titers
revealed <2-fold increase in 8 serotypes, 2-fold increase in 3
serotypes, and >2fold increase in 1 serotype, with no change in the
remaining 2 serotypes.  Tetanus, diphtheria, and Hib titers all
protective.  The specific question for her referral to me is whether or
not she could benefit from IVIG.  I think, probably not.  Any thoughts?

	                

	
________________________________


	How low will we go? Check out Yahoo! Messenger's low PC-to-Phone
call rates.
<http://us.rd.yahoo.com/mail_us/taglines/postman8/*http:/us.rd.yahoo.com
/evt=39663/*http:/voice.yahoo.com> 

 

 

--

 

-------------- next part --------------
An HTML attachment was scrubbed...
URL: http://seven.pairlist.net/mailman/private/pagid/attachments/20060807/034c7297/attachment.html