Referral

Primary Immunodeficiency - Adult

Scope

Patients over 16 years of age with suspected or known primary humoral (antibody), cell-mediated, or innate immune defects.

Out of Scope

Reversible secondary causes e.g. immunosuppressant drugs

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History

Details of infections – frequency, treatment response, admissions, complications

Immunisation history – dates, formulations

Examination

Respiratory, abdominal, lymph nodes

Differential Diagnosis

Reversible secondary causes should be excluded (see Management section below)

Features to suggest haematological malignancy, nephrotic syndrome

Full blood count with differential

Immunoglobulin levels and electrophoresis

Microbiological cultures as appropriate

Consider imaging as appropriate

Consider underlying causes of immunodeficiency, for example:

  • Medications (e.g. steroids, anticonvulsants, immunosuppression); haematological diseases (e.g. MGUS, myeloma, and CLL); proteinuria or diarrhoea/malabsorption

Treat infections according to usual protocols 5. Infections - North & East (devonformularyguidance.nhs.uk). Consider a second course of treatment if the infection hasn’t completely resolved.

Referral Criteria

Clinical concern regarding immunodeficiency, in particular recurrent, severe, or unusual infections.

If immunodeficiency is suspected referral should not be delayed pending blood results.

Referral Instructions

e-Referral Service Selection

Specialty: Immunology

Clinic Type: Immunology

Service: DRSS-Eastern-Allergy & Immunology-Devon ICB-15N

Referral Form

DRSS Referral Form

This guideline has been signed off on behalf of NHS Devon.

Publication date: July 2024