Table 5.
Initial and follow-up diagnostics in common variable immunodeficiency
| System | Type of diagnostic procedure | Intervals |
|---|---|---|
| Hematopoietic system | Blood formula and differential blood counts | (3-)6 months; more often in case of known autoimmune cytopenia |
| Coombs test in any case of newly developing anemia | On demand | |
| Bone marrow biopsy in case of suspicion of lymphoma or myelodysplasia | On demand at diagnosis or during follow-up | |
| Immune system | IgG, IgA, IgM (aiming at trough levels >7g/L) | |
| In intravenous immunoglobulin-substituted patients | Monthly trough levels | |
| In subcutaneous immunoglobulin-substituted patients | 1-3 months | |
| Immunofixation in serum and urine, ß2-microglobulin | At diagnosis | |
| CD3, CD4, CD8, CD19, CD56 lymphocyte subsets | Initially and repeatedly in case of suspected combined immunodeficiency | |
| Vaccination responses to tetanus, diphtheria, hepatitis, pneumococcal polysaccharides | At diagnosis | |
| Classification (detailed T/B-cell evaluation) | At diagnosis | |
| Microbiology (direct culture of pathogens, PCR, antigen ELISA) | Purulent sputum: determine colonizing pathogens and resistance pattern to antibiotics | On demand |
| In case of chronic bronchiectasis, control of colonising pathogens (Pseudomonas spp., Haemophilius influenzae, Streptococcus pneumoniae, Staphylococcus aureus, Candida spp. and others) with sensitivity to antibiotics | 6-12 months and on demand | |
| Lungs | Spirometry, CO diffusion test, blood gases | 12 months |
| Chest X-ray | (12-)24 months | |
| HR-CT in case of proven GILD | 24 months and on demand | |
| Bronchoscopy + BAL in case of suspicion of GILD | At diagnosis; on demand | |
| Lymphoproliferation | Abdomen sonography CT-Abdomen/MRT | 12 months |
| Lymph node biopsy | On demand; in case of suspected lymphoma | |
| Gastrointestinal tract | Oesophogastroscopy | In case of clinical symptoms and every |
| 24 months in case of increased risk for developing intestinal malignancy | ||
| Colonoscopy | On demand | |
| Central nervous system | MRT, liquor analysis in case of neurological symptoms (exclusion of enteroviral infection) | On demand |
BAL, bronchoalveolar lavage; CT, computed tomography; GILD, granulomatous interstitial lung disease; HR-CT, high-resolution computed tomography; MRT, magnetic resonance computed tomography.