Secondary Immunodeficiency

Question 1

Main difference from Primary Immunodeficiency (PID):
Age of onset - tend to be older
External cause
More common than PID ***

Answer 1

Main difference from Primary Immunodeficiency (PID):
Age of onset - tend to be older
External cause
More common than PID ***

Question 2

Common causes - 3?

Drugs - 4 types?

Answer 2

Severe malnutrition
Age extremes
Infections- HIV - AIDS

Immunosuppresive medication
Prednisolone******
Monoclonal Antibodies - adalimumab
Anticonvulsants

Question 3

Causes:

Anatomic Abnormality – damage to skin leading to infection

What will causes protein loss?

Type of cancer

What type of surgery and trauma?

Also, diabetes and uraemia

Answer 3

Nephrotic syndrome
Protein losing enteropathy

Haematological malignancies (CLL, multiple myeloma, lymphoma)

Burns – disrupts physical barrier
Disruption of epithelial barriers
Splenectomy – removal of splenic macrophages

Question 4

Tests:

FBC and film - why?

Immunoglobulins + electrophoresis

Serum free light chains - myeloma

Specific antibodies - why?

Lymphocyte - T cell levels

Urine dip + U&E - protein loss

Answer 4

Lymphocyte and neutrophil count + malignancy

Myeloma + Ig loss due to loss of protein

Specific antibody Deficiency (SpAD) - rare

Question 5

Management:

Remove cause.

Rx - 2

Answer 5

Consider Antibiotic prophylaxis

In some cases consider replacement immunoglobulin therapy