Tests
& Imaging > Labs
> Immunoglobulins
Last Update:
03/28/2012
|
Topics
About Immunoglobulins
|
Common
Immunoglobulins Values for Adults
Hypogammaglobulinemia
|
Intravenous Administration of Immunoglobulins |
Immunoglobulins
A to M  Immunoglobulins
(Ig)- a large family of proteins, also known
as
antibodies, providing a first-line of defense that protects the body from
infection - foreign
pathogens (virus, germs, parasites, etc.).
Produced by B cells, Igs play a
central role in humoral immunity, and deficiency may result in
dramatic consequences for the body's defense against infections.1
These protective antibodies are divided into five major classes:
IgG, IgM, IgA, IgE,
and IgD
NOTE: Rituxan treatment,
particularly long term use, is associated with decreased serum
immunoglobulins in some patients.
See
Hypogammaglobulinemia below.
While Ig infusions, may be considered in these situations -- when
there is also an increased incidence of infection -- this way of supplementing antibodies
requires infusions on a regular basis and is not without risks and
costs.
See for reducing risks:
http://www.cidpusa.org/ivig.html
Common
Immunoglobulins Values for Adults
Normal
Immunoglobulin levels vary by lab because of
differences in testing techniques. Reading
can also vary for adults versus children.
IgA
Immunoglobulin A
Protects against infections of the
mucous membranes lining the mouth, airways, digestive tract |
Est. Normal Range:
80 - 350 mg/dl |
IgG Immunoglobulin G
Major
type of antibody found in the blood that can enter tissues;
fights infection. |
Est. Normal Range:
620 - 1400 mg/dl |
IgM
Immunoglobulin M
Remains in the bloodstream where it can kill bacteria.
Elevated levels associated with Waldenström’s
Macroglobulinemia |
Est. Normal Range:
45 - 250 mg/dl |
IgD
Immunoglobulin D
Remains in the
bloodstream to fight bacteria |
Est. Normal Range:
.3 - 3.0 mg/dl |
IgE Immunoglobulin E
Frequently increased in parasitic infestations and atopic
individuals
(with allergic hypersensitivity) |
Est. Normal Range:
.002 - .2 mg/dl |
Resources
.gif) |
|
|
|
About Hypogammaglobulinemia (detailed
and technical)
Emedicine
Author: Robert Y Lin, MD; Chief Editor:
Michael A Kaliner, MD
|
|
|
Immunoglobulins Test
Results webMD.com
|
|
|
|
|
|
|
Rituxan-induced Hypogammaglobulinemia -
low levels of immunoglobulins (Igs) -
a common side effect of Rituximab maintenance;
associated with other treatments
and lymphoma as well
Scholar Topic Search
Immunoglobulins (Igs) produced by
B cells play a central role in humoral immunity, and deficiency may
result in dramatic consequences for the body's defense against
infections. The symptoms depend on the type and severity of the Ig
deficiency and the presence or deficiency of cellular immunity.
In general, hypogammaglobulinemia
results in recurrent infections with a restricted set of
microorganisms primarily localized to the upper and lower airways,
although bacteremia and GI infections can also occur..1
Key facts and questions related to Rituximab Maintenance:
|
|
The risks of a therapy
must be weighed against the potential benefits - the risks of the disease untreated or
treated differently. |
|
|
Deficiencies in Igs do not always lead
to infectious complications or the need to receive Intravenous Ig. |
|
|
Do the benefits of Rituximab
maintenance (improved PFS on average) outweigh the long-term risks? |
|
|
What is the clinical significance of low Igs
occurring from Rituximab maintenance? Is it reversible?
|
|
|
In one retrospective study, 55% of the
patient receiving Rituxan maintenance developed Ig deficiencies.
Of these, 20% (10/49) required intravenous Ig. |
-
About Hypogammaglobulinemia (detailed
and technical)
Emedicine
Author: Robert Y Lin, MD; Chief Editor:
Michael A Kaliner, MD
-
JCO, 2010: Hypogammaglobulinemia (hypogam) -
the impact of rituximab maintenance.
http://bit.ly/o1GMpo
Snapshot:
Retrospective study of 183 pts with normal (baseline) serum
immunoglobulin (sIg)
levels prior to Rituximab
26.7% (49) received
Rituximab
Maintenance while
73.2% (134) received as monotherapy (I) or Rituxan with chemotherapy
(CI).
Hypogam was documented in 39% (71/183) of pts with baseline normal sIg
levels following Rituximab
Rituximab Maintenance (RM) was associated with a higher risk of
developing hypogam,
55% (27/49) compared to
33% (44/134) receiving I or CI alone, p=0.006.
IVIG was administered to 13% (23/183) of pts with normal baseline sIg.
Among patients who received RM,
20% (10/49) received IVIG compared to
10% (13/134) among patients treated with I or CI alone, p=0.05.
IVIG for treatment of symptomatic hypogam was administered to
10% (18/183) of pts with normal sIg prior to Rituximab therapy (of any
kind).
-
Intravenous Administration of Immunoglobulins
|
|
Safety and Adverse Events Profiles of Intravenous
Gammaglobulin Products Used for Immunomodulation: A
Single-Center Experience
cjasn.asnjournals.org
It is important to understand
that all IVIg products are not alike. They differ in salt and
sugar content, pH, and osmolality. Careful attention to the
products that are provided by an institution’s pharmacy is
critical to avoid excipient-related adverse effects. On the
basis of our experience, all IVIg products can be administered
safely if adverse effect profiles are recognized and appropriate
patient selection and premedications are given. Because the use
and indications for IVIg continue to expand and higher doses and
volumes are mandated for autoimmune and inflammatory disorders,
it is critical to be aware of the potential adverse effects that
are associated with specific products and, more important, how
to prevent them. |
|
|
Intravenous immunoglobulin for the prevention of infection in
CLL.
nejm.org
A randomized, controlled clinical trial. Cooperative Group for the Study of Immunoglobulin in Chronic Lymphocytic Leukemia
|
|
|
FDA: Immune Globulin Subcutaneous (Human), Vivaglobin
http://bit.ly/bnpmBH
indication: Primary Immune Deficiency (PID)
|
Immunoglobulins A to M
|
IgA
Immunoglobulin A
Est. Normal Range:
80 - 350 mg/dl
Lab-specific
Varies by age
|
Immunoglobulin
A (IgA) is a type of antibody that protects against infections of the
mucous membranes lining the mouth, airways, and digestive tract.
|
|
|
|
|
SELECTIVE IgA DEFICIENCY
merck.praxis.MD
"Selective IgA deficiency is defined as less than 5 mg/dL of
serum IgA in the presence of normal concentrations of IgM and IgG.
Among the B-cell disorders it is the most commonly identified
deficiency. It occurs in one in every 500 to 1000 individuals in
Europe and the United States. It is less common in those of
African-American or Asian descent ... "
|
|
IgD
immunoglobulin D
Est. Normal Range:
.3 - 3.0 mg/dl
Lab-specific
Varies by age
|
IgD, immunoglobulin D is
mainly found on the surface of B-cells and may help regulate B-cell
function. The function of circulating IgD is unknown.
|
IgE
immunoglobulin E
Normal Range:
.002 - .2 mg/dl
Lab-specific
Varies by age
|
IgE, immunoglobulin E - the
protective role is not clear. IgE is frequently increased in parasitic infestations and atopic individuals.
IgE myeloma is extremely rare and should be sought after abnormal protein electrophoresis (restriction) and/or abnormal kappa/lambda ratio unexplained by IgG, IgA, or IgM. IgE is elevated 4-30 times normal in various diseases, among which atopic disorders and parasitic disorders are most prominent. The principal limitation of this test is the wide overlapping range of IgE values between atopic and nonatopic disease states.
.
|
IgG
immunoglobulin G
Est. Normal Range:
620 - 1400 mg/dl
Lab-specific
Varies by age
|
IgG, immunoglobulin G - the major antibody found in the blood that can enter tissues. It coats germs, helping other cells to seek and destroy
them.
|
|
|
|
|
IgG subclasses in healthy children and adults
xs4all.nl
|
|
|
IgG subclasses and humoral immunity -
xs4all.nl
|
|
IgM
immunoglobulin M
Est. Normal Range:
45 - 250 mg/dl
Lab-specific
Varies by age
|
IgM, immunoglobulin M - an antibody that remains in the bloodstream where it can kill bacteria that enter the blood stream.
Elevated levels of IgM are associated with Waldenström’s
Macroglobulinemia
"IgM in normal serum is often found to bind to specific
antigens, even in the absence of prior immunization. For this reason
IgM has sometimes been called a "natural antibody". This
phenomenon is probably due to the high avidity of IgM that allow it to
bind detectably even to weakly cross-reacting antigens
that are naturally occurring in nature" 1
-
|
Immuno-electrophoresis
serum/urine
|
Detects the
presence or absence of Immunoglobulins in the urine and assesses the
qualitative character (polyclonal vs. monoclonal) of the
immunoglobulins [1]
Normal Values: No, or small amount, of protein in the urine.
Abnormal: Immunoglobulin (antibodies) in the urine.
Possible indications: Kidney disorders,
multiple myeloma, Macroglobulinemia of Waldenstrom's, chronic lymphocytic
leukemia, a single clone of lymphocytes produces one type of immunoglobulin -- a monoclonal immunoglobulin. This is identifiable as monoclonal by
immunoelectrophoresis. You can have monoclonal immunoglobulins,
without it being a cancer, however.
-
|
|
