26/07/2019
الزملاء أطباء الأطفال والباطني وكوادر التمريض في المستشفيات الحكومية من جنين إلى رفح
Many children have B cell defects especially XLA, receive IVIG in the governmental hospitals. Their weight increase with age and the dose of IVIG should be increased accordingly. Many children are being ignored and routinely they receive the same dose at time of diagnosis. I have recently diagnosed several cases of bronchiactasis in these patients. This complication is a preventable one.
Check trough IgG level just before the infusion of the scheduled therapy. The trough IgG level should be above 600mg, if not increase the dose even if the patient is doing well. Most of patients need 400 mg / kg to achieve that , some need more.
If the patient is not doing well, increase the dose even if the trough level was more than 600 mg. You can reach monthly dose of 900 mg / kg if necessary.
We should not have seen bronchiactasis in these patients, but unfortunately we encountered some.
As the child turns 14 years, internal medicine departments become his place and internists become responsible for him. Internists in general lack the knowledge of primary immune deficiency and they think that immunologists only take care of pediatric patients.
Many pediatricians call me and consult me, but rarely ever to be consulted by internists, and most of newly diagnosed bronchiactasis were in patients above the age of 14 years. All pediatric patients with PID will be transferred to internal medicine units, and we don't want to lose all previous efforts to keep them healthy.
B cell defects mainly XLA and most of common variable immune deficiency and all case of AR hypogammaglobulinemia should live a normal life and we should not allow bronchiactasis to happen.
My office phone number 09 2332181, my mobile number is 0599653997.