Myeloma Screen
 

Serum Immunoglobulins

 
 
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Overview

  • Immunoglobulins, secreted by plasma cells, are made up of five classes - IgG, IgM, IgA, IgD and IgE.
    • Roles of Immunoglobulins

    • IgG - the most abundant immunoglobulin; also crosses the placenta
    • IgM - the first immunoglobulin secreted in response to foreign antigens
    • IgA - present in saliva, sweat, tears, breast milk and blood
    • IgD - bound to B-cell membranes; triggers B-cell activation
    • IgE - present in skin, mucous membranes and the lungs; involved in certain hypersensitivity reactions and response to parasitic infection
  • IgD and IgE are trace immunoglobulins and are not normally assessed.
  • Antibodies directed against specific pathogens (e.g. hepatitis B IgM and IgG) are useful in clinical practice, though total serum immunoglobulin levels are also useful for detecting inflammation, oligoclonal / monoclonal gammopathies and hypogammaglobulinaemia.

Elevated Immunoglobulins

    • Causes of Elevated Immunoglobulins

    • Infection
    • Inflammatory disease
    • Malignancy
    • Causes of Single Ig Elevation

    • Plasma Cell Neoplasms

    • Multiple myeloma
    • Smouldering myeloma
    • Monoclonal gammopathy of uncertain significance (MGUS)
    • Solitary plasmacytoma
    • AL amyloidosis
    • Others

    • Waldenstrom’s macroglobulinaemia
    • Chronic lymphocytic leukaemia (CLL)
    • Non-Hodgkin lymphoma (NHL)
    • Monoclonal (type II) cryoglobulinaemia

Hypogammaglobulinaemia

    • Causes of Hypogammaglobulinaemia

    • Inherited

    • Primary hypogammaglobulinaemia
    • Reduced Production

    • Malnutrition
    • Malignancy - especially CLL, lymphoma, multiple myeloma
    • Inflammatory disease - SLE, rheumatoid arthritis
    • Viruses - HIV, EBV, CMV, rubella
    • Increased Consumption

    • Sepsis
    • Severe burns
    • Protein-losing enteropathy
    • Nephrotic syndrome
 
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