[CIS PIDD] [cis-pidd] varicella vaccine prior to IGIV
CIS-PIDD
cis-pidd at lists.clinimmsoc.org
Wed May 10 19:06:49 EDT 2017
Richard:
I agree that he is unlikely to respond with effective antibody responses. Specifically he has low total IgG and IgG to VZV despite getting a higher dose VZV vaccine in Zostavax versus Varivax, and his switched memory B-cells are close to nil.
Although he could have Valtrex available should he break out after the vaccine, why take any risk?
Joe Church
From: cis-pidd at lyris.dundee.net [mailto:cis-pidd at lyris.dundee.net] On Behalf Of CIS-PIDD
Sent: Wednesday, May 10, 2017 2:25 PM
To: CIS-PIDD
Subject: [cis-pidd] varicella vaccine prior to IGIV (EXTERNAL EMAIL)
I am seeing a 63yo pediatric ophthalmologist who was treated for mantle cell lymphoma with an aggressive regimen including retuximab five years ago. Had medullary thyroid cancer 15 years ago and has had recurrent disease.
He was treated wit IGIV for about two years after his lymphoma diagnosis but then therapy was stopped. He has recurrent respiratory tract infections but no pneumonias, mostly sinusitis. Because of his recurrent infections and lab studies, he is willing to resume his IGIV therapy. Despite my discussion, he believes that his abnormalities of humoral immunity will be transitory and therefore he wants to be immunized prior to restarting IGIV. He wants varicella vaccine (see lab) and I am reluctant to give him a live virus vaccine. He received Zostvax about 2-3 years ago without difficulty. He also wants Prevnar and dTap despite my suggestion that he is unlikely to respond well. I have no problem giving those vaccines. By the way, the elevated IgM is not clonal at the protein level.
Would you give him varicella vaccine?
Thank you,
Richard Wasserman
Dallas
Immunoglobulin G, Qn, Serum
[L] 236 mg/dL 700-1600
Immunoglobulin A, Qn, Serum (001784)
Immunoglobulin A, Qn, Serum
[L] 46 mg/dL 61-437
Immunoglobulin M, Qn, Serum (001792)
Immunoglobulin M, Qn, Serum
[H] 522 mg/dL 20-172
Tests: (6) Varicella-Zoster V Ab, IgG (096206)
Varicella Zoster IgG [L] 137 index Immune >165
A second sample should be collected and tested no less than 2-4 weeks.
Negative <135
Equivocal 135 - 165
Positive >165
A positive result generally indicates exposure to the
pathogen or administration of specific immunoglobulins,
but it is not indication of active infection or stage
of disease.
Tests: (2) Pneumococcal Ab (23 Serotype) (812166)
Pneumo Ab Type 1* [L] <0.3 ug/mL >1.3
Pneumo Ab Type 3* [L] <0.3 ug/mL >1.3
Pneumo Ab Type 4* [L] <0.3 ug/mL >1.3
Pneumo Ab Type 8* [L] <0.3 ug/mL >1.3
Pneumo Ab Type 9 (9N)*
[L] <0.3 ug/mL >1.3
Pneumo Ab Type 12 (12F)*
[L] <0.3 ug/mL >1.3
Pneumo Ab Type 14* [L] 0.6 ug/mL >1.3
! Pneumo Ab Type 17 (17F)*
[L] <0.3 ug/mL >1.3
Pneumo Ab Type 19 (19F)*
[L] <0.3 ug/mL >1.3
! Pneumo Ab Type 2* [L] <0.3 ug/mL >1.3
! Pneumo Ab Type 20* [L] <0.3 ug/mL >1.3
! Pneumo Ab Type 22 (22F)*
[L] <0.3 ug/mL >1.3
Pneumo Ab Type 23 (23F)*
[L] <0.3 ug/mL >1.3
Pneumo Ab Type 26 (6B)*
[L] <0.3 ug/mL >1.3
Pneumo Ab Type 34 (10A)*
[L] <0.3 ug/mL >1.3
Pneumo Ab Type 43 (11A)*
[L] <0.3 ug/mL >1.3
Pneumo Ab Type 5* [L] <0.3 ug/mL >1.3
Pneumo Ab Type 51 (7F)*
[L] <0.3 ug/mL >1.3
Pneumo Ab Type 54 (15B)*
[L] <0.3 ug/mL >1.3
Pneumo Ab Type 56 (18C)*
[L] <0.3 ug/mL >1.3
Pneumo Ab Type 57 (19A)*
[L] <0.3 ug/mL >1.3
Pneumo Ab Type 68 (9V)*
[L] <0.3 ug/mL >1.3
Pneumo Ab Type 70 (33F)*
[L] 0.4 ug/mL >1.3
WBC 8.5 x10E3/uL 3.4-10.8
RBC 5.25 x10E6/uL 4.14-5.80
Hemoglobin 15.1 g/dL 12.6-17.7
Hematocrit 45.4 % 37.5-51.0
MCV 87 fL 79-97
MCH 28.8 pg 26.6-33.0
MCHC 33.3 g/dL 31.5-35.7
RDW 13.7 % 12.3-15.4
Platelets 246 x10E3/uL 150-379
Neutrophils 63 %
Lymphs 23 %
Monocytes 10 %
Eos 3 %
Basos 1 %
Neutrophils (Absolute)
5.4 x10E3/uL 1.4-7.0
Lymphs (Absolute) 2.0 x10E3/uL 0.7-3.1
Monocytes(Absolute) 0.9 x10E3/uL 0.1-0.9
Eos (Absolute) 0.3 x10E3/uL 0.0-0.4
Baso (Absolute) 0.1 x10E3/uL 0.0-0.2
Immature Granulocytes
0 %
Immature Grans (Abs) 0.0 x10E3/uL 0.0-0.1
Tests: (3) B-Cell Memory and Naive Panel (818314)
! B-cells % CD19 24 % 5-26
! B-cells Absolute CD19
466 cells/uL 58-558
! Naive B-cell %CD19+/CD27-/IgD+
82 % 29-93
! Naive BCL Abs CD19+/CD27-/IgD+
384 cells/uL 22-423
! Non-switched Memory %
10 % 2-25
! Non-switch Abs 47 cells/uL 4-66
! Class-switched Memory %
[L] <1 % 3-23
! Class-switched Abs [L] 2 cells/uL 4-62
! IgM Only Memory % 1.3 % .3-6.0
! IgM Only Memory Abs 6.1 cells/uL .6-16.4
! Total Memory B-cell%CD19/CD27+
12 % 7-48
! Tot Mem BCL Absol CD19+/CD27+
56 cells/uL 13-148
INTERPRETIVE INFORMATION: B-Cell Memory and Naive Panel
This panel is indicated for patients with suspected immune
deficiencies, especially Common Variable Immune Deficiency (CVID),
and to assess reconstitution of B-cell subsets after bone marrow
or stem cell transplant. Subsets measured: B-cells (CD19+), total
memory B-cells (CD19+ CD27+), class switched memory B-cells (CD19+
CD27+ IgD- IgM-), non-switched/marginal zone memory B-cells (CD19+
CD27+ IgD+ IgM+), IgM only memory B-cells (CD19+ CD27+ IgD-IgM+),
and naive B-cells (CD19+ CD27-IgD+).
Test developed and characteristics determined by ARUP
Laboratories. See Compliance Statement A: aruplab.com/CS<http://aruplab.com/CS>
Tests: (5) Rubella Antibodies, IgG (006197)
Rubella Antibodies, IgG
3.32 index Immune >0.99
Non-immune <0.90
Equivocal 0.90 - 0.99
Immune >0.99
Tests: (7) Rubeola Antibodies, IgG (096560)
Rubeola Ab, IgG 181.0 AU/mL Immune >29.9
Negative <25.0
Equivocal 25.0 - 29.9
Positive >29.9
Presence of antibodies to Rubeola is presumptive evidence
of immunity except when acute infection is suspected.
Tests: (8) Haemophilus influenzae B IgG (138271)
Haemophilus influenzae B IgG
0.16 ug/mL
NOTE: An anti-Hib level of 0.15 ug/mL is generally accepted as the
minimum level for protection. Optimal protection post-vaccination
requires a level greater than 1.00 ug/mL.
Tests: (9) Tetanus Antitoxoid IgG Ab (163691)
Tetanus Antitoxoid IgG Ab
0.42 IU/mL <0.10
Interpretation:
Non-Protective <0.10
Protective >=0.10
Results for this test are for research purposes
only by the assay's manufacturer. The performance
characteristics of this product have not been
established. Results should not be used as a
diagnostic procedure without confirmation of the
diagnosis by another medically established diagnostic
product or procedure.
Tests: (10) Diphtheria Antitoxoid Ab (163709)
Diphtheria Antitoxoid Ab
[L] <0.10 IU/mL <0.10
Interpretation:
Non-Protective <0.10
Protective >=0.10
For research use only.
Tests: (11) TgAb+Thyroglobulin,IMA or RIA (042060)
! Thyroglobulin Antibody
0.1 IU/mL 0.0-0.9
Thyroglobulin Antibody measured by Beckman Coulter Methodology
Tests: (12) Thyroglobulin by IMA (006705)
! Thyroglobulin by IMA [H] 454.0 ng/mL 1.4-29.2
According to the National Academy of Clinical Biochemistry, the
reference interval for Thyroglobulin (TG) should be related to
euthyroid patients and not for patients who underwent thyroidectomy.
TG reference intervals for these patients depend on the residual
mass of the thyroid tissue left after surgery. Establishing a
post-operative baseline is recommended.
The assay limit of quantitation is 0.1 ng/mL
Thyroglobulin measured by Beckman Coulter Immunometric Assay
--
Richard L. Wasserman, MD, PhD
Allergy Partners of North Texas
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
Fax (972) 566-8837
Cell (214) 697-7211
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