HNY Policy and Pathway Repository - North Yorkshire

Raised levels of immunoglobulins are a common finding as part of an acute phase response. If a distinct monoclonal protein is detected then refer to separate protocol for paraprotein investigation.

None provided

Differential Diagnosis:

The list of potential causes is vast and includes many infectious, inflammatory, malignant or autoimmune conditions.

Particularly high levels (IgG >30g/L) are most commonly associated with:

• Liver disease (~50%), inc. autoimmune hepatitis, viral hepatitis, primary biliary cirrhosis or alcohol induced liver disease
• Connective tissue disease (~25%), inc. Sjögren syndrome, rheumatoid arthritis or systemic lupus erythematosus
• Solid tumour (~5%)
• Chronic infection (~5%) including HIV
• Haematological disorders (<5%) such as lymphoma or leukaemia

Examination:

Given the wide range of possible causes a thorough general examination should be performed. The finding of lymphadenopathy should raise concern over an underling haematological malignancy, however, as shown above, this is not a common cause of a polyclonal gammopathy.

Baseline investigations:

• It is difficult to give specific recommendations given the wide range of possible causes so investigations should be led by clinical features.
• If no obvious cause then consider: FBC, U+E, LFT, calcium, CRP and autoimmune screen. Consider viral serology (hepatitis, HIV). Consider radiological imaging such as CXR and abdominal ultrasound.

Consider Haematology referral if:

• Features suggesting haematological malignancy (laboratory results, signs or symptoms).
• If no obvious cause but systemically unwell then consider referral to General Medicine.

Haematology Handbook - South Tees Hospitals NHS Foundation Trust
 

References:

Dispenzieri A, et al. Retrospective cohort study of 148 patients with polyclonal gammopathy. Mayo Clinic Proc 2001; 76: 476-487.

• South Tees Hospitals