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Referral
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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
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 - South & West (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-Western-Allergy & Immunology-Devon ICB-15N
Referral Form
This guideline has been signed off on behalf of NHS Devon.
Publication date: July 2024
