Acquired hypogammaglobulinaemia

Causes

• Malignant lymphoproliferative disorders including CLL and myeloma.

• Immunosuppressive therapy with e.g. azathioprine.

• Maintenance therapy for ALL.

• Nephrotic syndrome.

Clinical features

Bacterial infections—recurrent chest infections (may lead to bronchiectasis), sinus, skin and urinary tract infections common. Fulminant viral infections, especially measles, varicella.

Treatment

• May improve with treatment of the underlying disease.

• IVIg should not be used routinely as prophylaxis.

• High titre specific antibody can be given for serious zoster/varicella infections if available; polyvalent for measles.

• Patients with severe hypogammaglobulinaemia and recurrent infections may be considered for IVIg replacement therapy—give 200mg/kg every 4 weeks.

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