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Calculated globulin (CG) as a screening test for antibody deficiency
S Jolles1, R Borrell, S Zouwail
1Department of Immunology, University Hospital of Wales, Cardiff, UK.
Clinical and Experimental Immunology
|May 3, 2014
Summary
Low calculated globulin levels can detect antibody deficiency and paraproteins. This under-utilized screening method aids in early diagnosis and treatment for patients with immune deficiencies.
Area of Science:
- Clinical Chemistry
- Immunology
- Diagnostic Medicine
Background:
- Calculated globulin, derived from total protein and albumin, is typically part of liver function tests.
- Its primary use has been identifying high levels indicative of paraproteins.
- This study explored the utility of low calculated globulin levels for detecting antibody deficiency.
Observation:
- Serum samples with a calculated globulin cutoff < 18 g/l were analyzed from nine Welsh hospitals over 12 months.
- Albumin measurement methods (bromocresol green vs. bromocresol purple) were compared.
- Eighty-nine percent of samples showed immunoglobulin G (IgG) < 6 g/l using bromocresol green with the defined cutoff.
Findings:
- The screening method successfully identified patients with both primary and secondary antibody deficiencies.
- Serum electrophoresis and immunofixation revealed previously undetected paraproteins in 1.2% of cases, associated with immune-paresis.
- A different cutoff (< 23 g/l) was noted when using bromocresol purple for albumin measurement.
Implications:
- Screening using calculated globulin is a cost-effective, accessible method for detecting antibody deficiency and immune-paresis.
- This approach can significantly reduce diagnostic delays for antibody-deficient patients.
- Early detection facilitates timely initiation of immunoglobulin replacement therapy, improving patient outcomes.
