Had a blood test including testing for immunoglobulin.
First time I've seen IG results so don't understand them as much as WBC etc.
My IGa result is in red and is 0.84.
I believe the normal range is from 1.0
Those of you that have IVg treatment.
At what point does the clinician become concerned about IGa?
In other words is that figure of concern?
Thanks
Normal immunoglobulin range is;
Normal Ranges Adult: IgG 6.0 - 16.0g/L. IgA 0.8 - 3.0g/L. IgM 0.4 - 2.5g/L.
Your IgA level is therefore low normal.
They can only supplement your IgG and usually when it drops below 4 with frequent serious infections.
Newdawn
Thanks for that.
I need to stop worrying!
What was your IgG? That’s the crucial one but doesn’t sound like you need to be worrying unless you’re experiencing recurring, significant infections. It’s only given when absolutely justified because it’s scarce and very expensive!
Regards,
Newdawn
IGg was 6 and IGm <0.25
I have a phone consult with clinician on Wednesday.
Raised WBC but as I am relatively clear of infections (apart from ongoing cough for last 7 weeks which is slowly improving) should be ok to continue watch and wait in current climate I would expect.
Hope all doing ok
It’s trending lower but in the U.K., you’d be unlikely to be offered IVIG with those levels. Ask your doctor to keep an eye on them however as they’re not done routinely.
Incidentally, immunoglobulin levels don’t contribute to the CLL treatment criteria so you wouldn’t be given treatment based on them.
Newdawn
Both of my CLL specialists and my breast cancer specialist have told me that it is not unusual for us to have low IgA and IgM and that once they go down they may bounce a bit but it is very unlikely that they will go back to “in range”. They don’t feel that that presents a problem for most.
My IgG was very low at diagnosis - @250 (2.5 there?) and I was started on IVIG infusions right away. When looking at your numbers you need to look at “in range” for the lab that did your test on any given day. The bottom number of the range at the various labs connected with my center can vary as much as 50 (.5) for IgG. It drives me crazy, as it makes tracking my count impossible in their portal, or if I just want to look at in or out of range. IVIG usually kicks me up to @700 , but that number can be out of range on one report and 50 above in range on another.
See ncbi.nlm.nih.gov/pmc/articl... for a more complete discussion of Low IgA and CLL
I have been receiving IVIG every 4 weeks since 2011 when I had FCR treatment. I was recently transferred from an oncologist to a CLL specialist oncologist. He advised that his training taught that the maximum IVIG dosage is every other month. He had done a IGg level as required by a new insurance company. I had similar results: normal IGg but low IGa and IGm.
When I described my very stubborn sore throat and cold over the Christmas holidays (with monthly IVIG) he agreed to continue monthly IVIG and the insurance company approved it through July. However I am considering rescheduling my IVIG April 2 due to the risks of exposure to covid 19 in the infusion clinic. I have emailed the oncologist to ask him about it.
The half life of IgG is about 22 days, which I have personally verified. (I worked out what half life provided the best fit with my averaged IgG blood test results after dropping from the calculated peak IgG result from my infused IgG into my blood volume, allowing for the small amount of IgG I was still making).
To give a practical example, if your IgG count is 3 (or 300 in most US labs), and you are given a 40 gram infusion into your 5 litres of blood, your IgG climbs to (3 + 40/5) or 11 (11,000). About 22 days later, half your infused IgG has gone, so your IgG is (3 + 20/5) or 7. A bit over 2 months or 66 days after your infusion, you will only have 1/8 of your IgG infusion left (3 half lives), so your IgG will be about (3 + 5/5) or 4. So for much of the second month, your IgG will be below the lower normal IgG reference range.
That's why the time between regular infusions in the UK and Australia is 4 weeks, not 2 months. That's also why subcutaneous weekly IgG infusions do far better at keeping your IgG levels within the reference range. Subcutaneous infusions actually do even better than IV infusions, because it takes between 2 and 5 days for the IgG to diffuse out of the subcutaneous skin injection site into the blood stream.
Neil
Thank you for the information! For what it’s worth, my IGg level was drawn 26 days after the last IVIG of 30g.
Follow up: my infusion clinic at the University of Alabama in Birmingham is rescheduling all non-chemotherapy infusion appointments due to covid 19.
My March infusion was cancelled and I’m sure April’s will be also. My doctor and I agreed that the risk of exposure is greater than the benefit of IVIG. I have gone for two months between infusions for several months over the years, but always end up back on monthly, but in 17 years I have had one flu and a handful of UTIs as opposed to living from infection to infection before diagnosis. Love my IVIG! Hopefully self isolating will get me past the worst of these times. I expect that we will be isolating for a minimum of 3 months.
Thanks for the reassurance!
A key factor is infections. If you have multiple infections with fever that do not resolve with antibiotics, IVIG or SCIG may be prescribed by your hemotologist/oncologist. They may not prescribe it if if you have IgG below 4g/L without infection. Other specialists, such as Immunologists, do not adhere to the 4g/L limit, and may use titres before and after vaccine instead.
BTW, IgG levels do not yet matter for COVID-19, since the donated plasma that Ig products are made from likely does not have antibodies yet, and may not for some months in the future. IVIG and SCIG are different products from some of the other Ig-based products being researched, and mentioned in other threads.
Even though my levels are normal, the insurance (Medicare plus United Healthcare Plan F supplement) has approved IVIG every 28 days since early 2017 due to 13 months of chronic bronchitis unresponsive to antibiotics. I am not sure the numbers have always been normal, but they were when a different hemonc (away for 6 weeks) tested them. My usual doc. tests CBC each month and metabolic panel every 3 months. The IVIG has eliminated the constant coughing from the bronchitis. It has been a huge help.
Immunoglobulin levels improved at last (after 19 months on Ibrutinib)
HOW DO WE DETERMINE MUTATION STATUS?
I just finished Cycle 6th on my Venetoclax plus Ibruvica trial. So far so good!!
Bmb results confused 
Monoclonal gammopathy and serum immunoglobulin levels as prognostic factors in chronic lymphocytic leukaemia
