Comparison of reference systems in the assessment of age-related serum immunoglobulin levels in pediatric patients
Comparison of reference systems in the assessment of age-related serum immunoglobulin levels in pediatric patients
Background/aim: Ig level assessment is frequently used in the diagnosis and follow-up of immunodeficiency, as well as in studiesinvestigating the prevalence of low serum Ig level in specific diseases.Material and methods: Patients who underwent Ig testing in the inpatient and outpatient clinics of our hospital in the years 2010–2016were included. The Ig levels of the patients were assessed separately according to two reference systems commonly used in Turkey andanother reference system used in the USA.Results: A total of 20,138 patients (57.6% male) were included in the study. The median age of the patients was 55.7 months (interquartilerange: 23.1–96.7). According to the reference intervals determined by Tezcan et al., 30.6% of the patients were deficient in one or more Igvalues. This rate was 4 times higher than those based on the reference intervals determined by Aksu et al. (7.7%) and those in the NelsonTextbook of Pediatrics (6.8%). We also determined that the frequency of low Ig levels with three reference systems.Conclusion: In this study, we found that the rates of low Ig level in a group of pediatric patients differed significantly when evaluatedusing three different reference systems for age-related serum Ig levels
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- 1. Bonilla FA, Khan DA, Ballas ZK, Chinen J, Frank MM, Hsu JT,
Keller M, Kobrynski LJ, Komarow HD, Mazer B et al. Practice
parameter for the diagnosis and management of primary
immunodeficiency. J Allergy Clin Immunol. 2015 Nov; 136:
1186-1205.
- 2. Modell V, Gee B, Lewis DB, Orange JS, Roifman CM, Routes
JM, Sorensen RU, Notarangelo LD, Modell F. Global study of
primary immunodeficiency diseases (PI)-diagnosis, treatment,
and economic impact: an updated report from the Jeffrey
Modell Foundation. Immunol Res. 2011; 51: 61-70.
- 3. Yel L, Rabbat CJ, Cunningham-Rundles C, Orange JS, Torgerson
TR, Verbsky JW, Wang Y, Fu M, Robins TS, Edwards MS et al.
A novel targeted screening tool for hypogammaglobulinemia:
measurement of serum immunoglobulin (IgG, IgM, IgA) levels
from dried blood spots (Ig-DBS assay). J Clin Immunol 2015;
35: 573-582.
- 4. Notarangelo LD. Primary immunodeficiencies. J Allergy Clin
Immunol 2010; 125: 182-194.
- 5. Tezcan İ, Berkel A.İ, Ersoy F, Sanal Ö. Sağlıklı Türk çocukları
ve erişkinlerde turbidometrik yöntemle bakılan serum
immunoglobulin düzeyleri. Çocuk Sağlığı ve Hastalıkları Dergisi
1996; 32: 649-656.
- 6. Solberg HE. The IFCC recommendation on estimation of
reference intervals. The RefVal program. Clin Chem Lab Med
2004; 42: 710-714.
- 7. Schauer U, Stemberg F, Rieger CH, Borte M, Schubert S, Riedel
F, Herz U, Renz H, Wick M, Carr-Smith HD et al. IgG subclass
concentrations in certified reference material 470 and reference
values for children and adults determined with the binding site
reagents. Clin Chem. 2003; 49: 1924-1929.
- 8. Aksu G, Genel F, Koturoğlu G, Kurugöl Z, Kütükçüler N. Serum
immunoglobulin (IgG, IgM, IgA) and IgG subclass concentrations
in healthy children: a study using nephelometric technique. The
Turkish Journal of Pediatrics 2005; 47: 19-24.
- 9. RM Kliegman, NF Schor, JW St. Geme III, B Stanton. Reference
intervals. Nelson Textbook of Pediatrics. Philedelphia, PA, USA:
Elsevier, 2016.
- 10. Oliveira JB, Fleisher TA. Laboratory evaluation of primary
immunodeficiencies. J Allergy Clin Immunol 2010; 125: 297-305.
- 11. 11. Baris S, Karakoc Aydiner E, Ozen A, Ozdemir C, Bahceciler
N, Barlan IB. Serum immunoglobulin levels as a predictive factor
for a better outcome of nonatopic childhood asthma. Pediatr
Allergy Immunol. 2011; 22: 298-304.
- 12. 12. Ercan H, Ispir T, Kirac D, Baris S, Ozen A, Oztez S, Cengizlier
MR. Predictors of atopic dermatitis phenotypes and severity:
Roles of serum immunoglobulins and filaggrin gene mutation
R501X. Allergol Immunopathol (Madr) 2013; 41: 86-93.
- 13. 13. van den Akker EH, Sanders EA, van Staaij BK, Rijkers
GT, Rovers MM, Hoes AW, Schilder AG. Long-term effects of
pediatric adenotonsillectomy on serum immunoglobulin levels:
results of a randomized controlled trial. Ann Allergy Asthma
Immunol 2006; 97: 251-256.
- 14. 14. Baskın Y, Yiğitbaşı T, Afacan G, Akgün F, Dere R. reference
intervals for serum immunoglobulın (IGA, IGG, IGM) and
IGG subclasses in healthy subjects. Turk J Biochem 2010; 35;
325-333.
- 15. 15. Plebani A, Ugazio AG, Avanzini MA, Massimi P, Zonta L,
Monafo V, Burgio GR. Serum IgG subclass concentrations in
healthy subjects at different age: age normal percentile charts.
Eur J Pediatr. 1989; 149: 164-167.
- 16. 16. Lau YL, Jones BM, Ng KW, Yeung CY. Percentile ranges for
serum IgG subclass concentrations in healthy Chinese children.
Clin Exp Immunol. 1993; 91: 337-341.
- 17. 17. Vlug A, Nieuwenhuys EJ, van Eijk RV, Geertzen HG,
van Houte AJ. Nephelometric measurements of human IgG
subclasses and their reference ranges. Ann Biol Clin. 1994; 52:
561-567.
- 18. 18. Lock RJ, Unsworth DJ. Immunoglobulins and
immunoglobulin subclasses in the elderly. Ann Clin Biochem.
2003; 40: 143-148.
- 19. 19. Morais IPA, Tóth IV, Rangel AOSS. Turbidimetric and
nephelometric flow analysis: concepts and applications.
Spectroscopy Letters. 2006; 39: 547-579.
- 20. 20. Denham E, Mohn B, Tucker L, Lun A, Cleave P, Boswell
DR. Evaluation of immunoturbidimetric specific protein
methods using the Architect ci8200: comparison with
immunonephelometry. Clin Biochem. 2007; 44: 529-536.
- 21. 21. Blirup-Jensen S. Protein standardization III: method
optimization basic principles for quantitative determination
of human serum proteins on automated instruments based on
turbidimetry or nephelometry. Clin Chem Lab Med 2001; 39:
1098-1109.