Definition and Overview

An immunodeficiency follow-up is a series of appointments with an immunologist and other specialists for the treatment of infection, management of disease, and monitoring of ongoing treatment.

Patients with immunodeficiency conditions have to see their immunologists on a regular basis. Depending on the severity of the disease, patient’s prognosis, and overall health condition, they may have to see their physician once every two weeks. For those with non life-threatening conditions, annual follow-up is often mandatory to monitor the progress of the condition.

Who Should Undergo and Expected Results

The follow-up is recommended for individuals who have been diagnosed with either primary or secondary immunodeficiency disorders or conditions.

Primary immunodeficiency disorders are characterised by the absence or insufficient immunity usually due to genetic anomalies that normally begins as soon as the baby is born. Some of the well-known primary immunodeficiency diseases are common variable immunodeficiency (CVID), severe combined immunodeficiency (SCID), and alymphocytosis.

On the other hand, secondary disorders are the result when the immune system becomes compromised due to the presence or invasion of a life-threatening threat such as a virus or toxic chemicals. This happens when the virus has the ability to hide itself from the immune system or replicate quickly that the immune system cannot quickly cope with it. AIDS (acquired immunodeficiency syndrome) is one of the most common kinds of secondary immunodeficiency disease.

The immune system acts as the body’s natural defense against many kinds of threats like bacteria, viruses, and toxic chemicals. If it’s compromised, the person becomes vulnerable to different infections, many of which can be life threatening. A follow-up therefore doesn’t only monitor the patient's condition but more importantly, it helps the patient enjoy a better quality of life and prevents death.

How Does the Procedure Work?

The immunodeficiency follow-up is done either on an inpatient or outpatient basis. Inpatient care is provided when the patient is currently suffering from an infection. Due to the missing or compromised immunity, hospitalisation is needed to closely monitor the effects of the treatment and isolate the patient from further threats.

The follow-up is conducted with an immunologist, a specialist in immunity, who can also collaborate with other specialists depending on the condition and procedures to be performed. For example, if the patient is diagnosed with pneumonia, he may visit both an immunologist and a lung doctor or pulmonologist.

During the follow-up, the immunologist reviews the patient’s medical records. Physical exam and other types of tests like blood work and imaging tests will be conducted to monitor the progress of the condition, detect any potential health issue, and obtain a more accurate assessment of the patient’s health.

Certain immunodeficiency disorders require regular treatment, which can be performed during the follow-up. For example, patients with CVID can be given plasma infusions or plasma exchange. The follow-up may also be a good time to determine the quality of treatment. If the patient has become less or unresponsive to medications, for example, the immunologist will make necessary adjustments.

Usually, a follow-up takes less than an hour but could be longer if tests are to be conducted.

Possible Risks and Complications

The different treatments that can be performed during a follow-up do not provide a guarantee that the disease can be cured. They also don’t prevent possible recurrent infections and even death. Moreover, the need to visit different physicians on a regular basis may prove to be time-consuming and exhausting for the patient.

Also, these follow-up sessions are usually something that both children and parents are not looking forward to particularly if they have to go through exams and treatments in between. Children can become fussy that appointments may take longer than they should.


Reference

  • Ballow M. Primary immunodeficiency diseases. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 258.
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