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Immunoglobulins (IgA, IgG, IgM)

Blood Sciences Test Blood Transfusion


Specimen

Serum

Special Instructions

Units g/L

Reference Range

Age IgA IgG IgM
Up to 2 weeks 0.01 – 0.08 5.0 – 17.0 0.05 – 0.20
2 – 4 weeks 0.02 – 0.15 3.9 – 13.0 0.08 – 0.40
1 – 3 months 0.05 – 0.40 2.1 – 7.7 0.15 – 0.70
3 – 6 months 0.10 – 0.50 2.4 – 8.8 0.20 – 1.00
6 – 9 months 0.15 – 0.70 3.0 – 9.0 0.40 – 1.60
9 – 12 months 0.20 – 0.70 3.0 – 10.9 0.60 – 2.10
1 – 2 years 0.30 – 1.20 3.1 – 13.8 0.50 – 2.20
2 – 3 years 0.30 – 1.30 3.7 – 15.8 0.50 – 2.20
3 – 6 years 0.40 – 2.00 4.9 – 16.1 0.50 – 2.00
6 – 9 years 0.50 – 2.40 5.4 – 16.1 0.50 – 1.80
9 – 12 years 0.70 – 2.50 5.4 – 16.1 0.50 – 1.80
12 – 15 years 0.80 – 2.80 5.4 – 16.1 0.50 – 1.90
16 – 45 years 0.80 – 2.80 6.0 – 16.0 0.50 – 1.90
Over 45 years 0.80 – 4.00 6.0 – 16.0 0.50 – 2.00

Immunoglobulin and protein electrophoresis requests

All areas of the Trust are in the process of ensuring that they deliver a cost effective service within an increasingly limited resource. The blood sciences laboratory continues to strive to deliver a cost effective service therefore we request that specific requests for serum electrophoresis and immunoglobulins are made as outlined below.

We recommend that requests for Serum Electrophoresis only are made if the identification or exclusion of a paraprotein in the serum (i.e. myeloma, MGUS, etc) is being investigated. Serum Immunoglobulin quantification is then only undertaken if a paraprotein is identified. It is recommended that a urine sample is provided to the laboratory WITH the serum sample to allow identification of free light chain (Bence Jones protein) in the urine if present.

Requests for immunoglobulins only should be made in the context of systemic inflammatory illnesses and immunodeficiency.

If immunodeficiency is a concern and you wish to discuss the best approach for diagnosis or monitoring treatment of this condition, please contact Dr Claire Bethune, Consultant Immunologist on 01752 431675 or email on claire.bethune@nhs.net

Serum electrophoresis will rarely be added at the validation stage by the duty biochemist if thought appropriate. The majority of serum electrophoresis requests from patients with inflammatory or infectious diseases are of low specificity in both diagnosis and management.

 

Brief guide to interpretation – ADULTS

High IgA (>4g/L)

Elevated IgA levels are nonspecific, but can be seen in pulmonary and gastrointestinal inflammatory diseases, some autoimmune conditions, liver disease, and plasma cell disorders.

 

Low IgA (<0.8g/L)

Partial or complete IgA deficiency affects up to 1% of the population, and is commonly asymptomatic.  Patients may have a slightly higher risk of gastrointestinal diseases (including coeliac disease), autoimmune disease, or a modest increase in the rate of superficial infections.

 

High IgM (>2g/L)

Elevated IgM levels are a nonspecific marker of inflammation, but can be associated with liver disease

 

Low IgM (<0.5g/L)

Low IgM levels are commonly nonspecific.  Significance of this result depends on the clinical presentation and other laboratory parameters.

 

High IgG (>16g/L)

Elevated IgG levels can be seen in chronic active infection or inflammation, or in association with plasma cell disorders.

 

LOW IgG

IgG 5- 5.9g/L

Mild hypogammaglobulinaemia is commonly nonspecific.  Suggest repeat in 3 months.   Suggest discussing with clinical immunology if there are recurrent bacterial infections.

 

IgG 3-4.9g/L

Moderate hypogammaglobulinaemia is often associated with recurrent bacterial infections.  If persistently low, consider discussing with Dr Claire Bethune, Consultant Immunologist on 01752 431675 or email on claire.bethune@nhs.net.

 

IgG 0-2.9g/L

Significant hypogammaglobulinaemia confers a high risk of serious bacterial infections.  Suggest check full blood count and consider secondary causes.  Please contact Dr Claire Bethune, Consultant Immunologist on 01752 431675 to discuss or email on claire.bethune@nhs.net

 

Brief guide to interpretation – PAEDIATRICS

 

High IgA (above normal range)

Elevated IgA levels are nonspecific, but can be seen in pulmonary and gastrointestinal inflammatory diseases, some autoimmune conditions, liver disease, and plasma cell disorders.

 

Low IgA (below normal range)

Partial or complete IgA deficiency affects up to 1% of the population, and is commonly asymptomatic.  Patients may have a slightly higher risk of gastrointestinal diseases (including coeliac disease), autoimmune disease, or a modest increase in the rate of superficial infections.

 

High IgM (above normal range)

Elevated IgM levels are a nonspecific marker of inflammation, but can be associated with liver disease

 

Low IgM (below normal range)

Low IgM levels are commonly nonspecific.  Significance of this result depends on the clinical presentation and other laboratory parameters.

 

High IgG (above normal range)

Elevated IgG levels can be seen in chronic active infection or inflammation, or in association with plasma cell disorders.

 

 

LOW IgG 

IgG (<20% below the normal range)

Mild hypogammaglobulinaemia is commonly nonspecific.  Suggest repeat in 3 months.  If persistently low, check full blood count. Suggest discussing with clinical immunology if there are recurrent bacterial infections.

 

IgG (>20% below the normal range)

Hypogammaglobulinaemia is often associated with recurrent bacterial infections, which may be serious.  Suggest check full blood count serum and consider secondary causes.  Consider discussing with clinical immunology service on 01752 431675.

 

Turnaround Time

3 day

Availability

Local test

Can be added on to an existing request up to 4 days following sample receipt

Minimum Repeat Interval

20 days

Specimen Labelling Procedure
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