Are primary immunodeficient patients on immunoglobulin replacement receiving adequate monitoring?

Background: The immunology department at the Newcastle Upon Tyne NHS Foundation Trust has 90 patients currently receiving replacement immunoglobulin for both primary and secondary immunodeficiencies. The aims of the study were to ensure compliance with departmental and national monitoring guidelines in the following areas 1. Documentation of current patient weight and immunoglobulin as a dose/kg/month. 2. Measurement of trough IgG at 6 monthly intervals 3. Measurement of liver function tests (LFT) at 6 monthly intervals 4. Annual pulmonary function test (PFT) measurement 5. Ensuring an adequate trough IgG. Methods: An initial retrospective study of 27 patients randomly selected from a total of 90 patients on the primary immunodeficiency database within the Immunology Department was carried out. Data was collected by reviewing the database and patient notes. Results: Trough IgG, LFTs and PFTs were regularly reviewed in 89%, 93% and 44% of cases respectively. Trough IgG was considered adequate in 85% of patients while 7 patients were identified to have abnormal LFTs. Finally, 15% of patients did not have a documented weight. Discussion: Actions points included the possible introduction of in-house spirometry to enhance lung function monitoring by improving patient access. A management plan will be discussed with the hepatologists regarding referral and investigation for abnormal LFTs. A further survey is planned to identify all patients with a sub therapeutic IgG trough and document potential causes. A reaudit is planned for 2015.