[CIS-PAGID] Asymptomatic hypogammaglobulinemia

[Saxon, Andy M.D.]

Hi Joe! Happy holidays to you and yours!

These patients are always optional in terms of IVIg. I have seen quite a few over the years.  They have not been seriously ill and have no end organ damage or other risks.  The danger is overwhelming sepsis with death for one can always start Ig Rx if they get sick and survive the initial infection.My approach is to discuss it with the patient in terms of "insurance" - what do they want to expend in terms of money/time vs protection they want to purchase.  If they choose not to take the Ig replacement, I give them careful instructions about what to do with the early signs of infection, etc. There is no "right" answer for all of this type of patient.

The most dramatic one I ever saw was a physician who had less than 100 mg/dl of IgG and undetectable IgM and IgA. He'd known about it for 10 years and decided to do nothing. He I was uncomfortable with having no replacement but it was his decision... Here is his PEP and IFE - NOTHING
[cid:015275515 at 30122010-0FB2]
Andy Saxon, not in the Rose Bowl UCLA

________________________________
From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Church, Joseph
Sent: Thursday, December 30, 2010 7:29 AM
To: pagid at list.clinimmsoc.org
Subject: [CIS-PAGID] Asymptomatic hypogammaglobulinemia

Colleagues:

I am seeing a 42yo man with no significant infection history.  A low globulin fraction on a chem. panel lead to his primary MD to obtain QUIGs:  IgG 309, IgA <7, IgM 30.  He has protective tetanus and Hib antibody, but responded to only 3 of 23 serotypes following Pneumovaxtm.

Review of past chem. panels suggest these finding have been present for 10 years.

Glaum and Levinson reported similar patients (Ann Allergy Asthma Immunol 2008;100:396-7), but I could not get a sense of what they did about their findings.

Should patients like this be placed on immunoglobulin replacement?

Joe Church
Children's Hospital Los Angeles

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