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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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