What is included in long-term monitoring of hypogammaglobulinemia?

Updated: Dec 26, 2018
  • Author: Elizabeth A Secord, MD; Chief Editor: Michael A Kaliner, MD  more...
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Answer

See the list below:

  • Regular follow-up of the following parameters is necessary:

    • Growth and development should be monitored in children.

    • Chest radiograph and, if pulmonary abnormalities are suggested, high-resolution CT (HRCT) should be performed and repeated annually or as appropriate.

    • Pulmonary function tests should be performed and, if abnormal, monitored annually.

    • Immunoglobulin trough levels greater than or equal to 500 mg/dL are considered satisfactory, but levels greater than 600 mg/dL may be beneficial in patients with chronic lung or sinus disease. Doses and treatment intervals should be titrated in individual patients to determine the level needed to prevent recurrent infection without excessive use of this expensive medication.

    • Liver function tests should be performed and, if abnormalities are identified, nucleic acid tests should be used to determine if a potentially blood-borne infection (such as viral hepatitis) is present. Repeated results that suggest biliary disease may require follow-up with imaging studies of the liver and/or biliary tree to rule out malignancies or sclerosing cholangitis (the latter is seen in X-linked hyper-IgM syndrome [XHM]).

    • Lymphocyte surface marker analysis and serum immunoelectrophoresis may be indicated at routine intervals to screen for lymphoma and other malignancies.


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