Immunodeficiency disorders
Red flags
Consider urgent referral for patients with the following
- Recurrent severe infection
Immunodeficiency may be primary or secondary. Primary immunodeficiencies are a diverse group of mono- and polygenic disorders affecting immune function. Secondary immunodeficiency occurs as a result of another condition/treatment such as lymphoproliferative disease or immunosuppressive therapy for autoimmunity or malignancy. The most common conditions affecting adults are secondary immunodeficiency (particularly secondary antibody deficiency) and Common Variable Immunodeficiency (CVID).
Conditions in this category include:
- Chronic granulomatous disease
- Common variable immunodeficiency
- Secondary hypogammaglobulinaemia – excluding those associated with haematological treatment. These should be discussed with treating haematology team.
- DiGeorge syndrome Combined immunodeficiency
- X-Linked agammaglobulinaemia
- Hereditary angioedema
- IgA deficiency, IgM deficiency and IgG subclass deficiency
- Patients are usually asymptomatic with no clinical immunodeficiency. Referrals for asymptomatic individuals with IgA deficiency, IgM deficiency or IgG subclass deficiency will not be routinely accepted. Please provide a detailed history of the patient’s susceptibility to infection if referring for these conditions.
- Isolated partial or total IgA deficiency
- Relatively common in the general population (approximately 1:300 individuals) and is not normally associated with clinical immunodeficiency. The finding of IgA deficiency is not clinically relevant if the clinical situation is not consistent with immunodeficiency (I.e there are no infections). Referrals for asymptomatic IgA deficiency will not be accepted.
- IgG subclass deficiency
- IgG subclass deficiency with normal total IgG is not associated with clinical immunodeficiency in most cases. Referrals for asymptomatic IgG subclass deficiency with preserved total IgG will not be accepted unless a detailed clinical history is provided with the referral suggesting susceptibility to infection.
Most of these disorders are rare and referral will usually be for continuing management when patients move area. Ensure that if seen by a previous specialist, copies of the last 2-3 letters are included.
Out of scope conditions:
- HIV infection – please refer to Infectious Diseases
Referral requirements
A referral may be rejected without the following information.
- History of infections (documented microbiology if possible) including frequency and antibiotic therapy
- History of vaccinations
- Family history of infection
- History of immunosuppressive therapy or chemotherapy
- Detailed current medication list
- If patient is moving from another catchment, please include specialist correspondence.
Additional referral information (useful for processing the referral)
Investigations to consider:
- FBC, Chem-20
- IgG/A/M (IgG subclasses not required) within the last six months.
- Lymphocyte Subsets (including CD4 and CD19 counts)
- Neutrophil oxidative burst – for recurrent pyogenic bacterial skin or respiratory tract infections, fungal infections, Candidiasis.
- HIV serology
Out of catchment
Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.
- Impact on employment
- Impact on education
- Impact on home
- Impact on activities of daily living
- Impact on ability to care for others
- Impact on personal frailty or safety
- Identifies as Aboriginal and/or Torres Strait Islander
- To establish a diagnosis
- For treatment or intervention
- For advice and management
- For specialist to take over management
- Reassurance for GP/second opinion
- For a specified test/investigation the GP can’t order, or the patient can’t afford or access
- Reassurance for the patient/family
- For other reason (e.g. rapidly accelerating disease progression)
- Clinical judgement indicates a referral for specialist review is necessary
- Presenting symptoms (evolution and duration)
- Physical findings
- Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
- Body mass index (BMI)
- Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
- Current medications and dosages
- Drug allergies
- Alcohol, tobacco and other drugs use
- Full name (including aliases)
- Date of birth
- Residential and postal address
- Telephone contact number/s – home, mobile and alternative
- Medicare number (where eligible)
- Name of the parent or caregiver (if appropriate)
- Preferred language and interpreter requirements
- Identifies as Aboriginal and/or Torres Strait Islander
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Signature
- Willingness to have surgery (where surgery is a likely intervention)
- Choice to be treated as a public or private patient
- Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
Send referral
Hotline: 1300 364 938
Medical Objects ID: MQ40290004P
HealthLink EDI: qldmnhhs
Mail:
Metro North Central Patient Intake
Aspley Community Centre
776 Zillmere Road
ASPLEY QLD 4034
Health pathways
Access to Health Pathways is free for clinicians in Metro North Brisbane.
For login details email:
healthpathways@brisbanenorthphn.org.au
Login to Brisbane North Health Pathways:
brisbanenorth.healthpathwayscommunity.org