Low IgG Blood levels for subclass 1

Hello All,

My IgG subclass 1 was low. My hematologist is planning to treat me at next visit if my platelets continue to fall. They were at 30,000 last visit. He wants to do prednisone and then n plate. I had wanted ivig. I have a history of lyme. Also my bone marrow biopsy had slight abnormal hypersegmented neutrophils.Differential was MDS, though it said unlikely due to age. I am 45. I don't want to take prednisone. Is it contraindicated with low immune subclasses? Where does IgG fit in to the treatment plan? Why is it tested?

Hi Jen. I'm not sure why your Hemo tested your IgG, maybe just to be on the safe side. Sometimes people with ITP have CVID (Common Variable Immune Deficiency) and maybe he was playing it safe, or maybe he tested because of the bone marrow results.

I don't like the idea of Prednisone or N-Plate with the things that you have/had going on. Prednisone isn't the best idea if someone has a low immune system. IVIG does seem to be the safest route, although it might be the most time consuming and probably won't last long. It can get old real fast.

This will be a tough decision if you do have to treat. I always say it would be nice to have a crystal ball because none of us can possibly foresee the long term results of the choices we have to make. Maybe a second opinion?

I'd suggest seeing an immunologist about the low IgG. It may be that it isn't low enough to worry about or they may find other things which haven't been tested for yet. Primary Immune Deficiencies (PIDs) often cause autoimmune disorders and ITP is the commonest so it would be worth pursuing. If you are going to treat the ITP it would be worth having an immunologist around to ensure that your immune system doesn't suffer too much.

Nplate is contra-indicated in MDS

Thank you, Sandy. I will be seeing someone for a second opinion Nov. 10. I just hope we don't have to treat before then. I also started acupuncture and herbs and my energy has been better. Still having heart palpitations and really dry eyes and mouth. They referred me to a rheumatologist but it is not until January. Feeling frustrated.

I totally understand that frustration. I go through the same thing with multiple doctors and get passed around from specialist to specialist. I call myself a Hot Potato because no one seems to know what to do so I get shoved off to the next doctor. Things do not move very fast in the medical profession. I also have dry eyes and dry mouth and there isn't much you can do about it, even with a diagnosis. Sjogren's can cause that. They usually just suggest Restasis (eye drops) for the eyes and mouth washes or gum for the dry mouth. I've done those and they don't help much, but that's all there is. You can get some OTC's in the meantime, but managing symptoms is sometimes the only thing to do.

More info: The name of the gum I use is Spry. It helps temporarily when my mouth is so dry that I can't work up any saliva at all. I have problems with my salivary glands too...had an infected one that swelled up for a few weeks, and get a weird jaw pain every time I take a bite of something. That can also be part of it.

As for the eyes, I tried to switch from contacts to glasses last winter because my eyes were so dry. I found that wearing glasses made it even worse. I used Restasis during that time, plus another OTC tear replacement drop and I was miserable. I couldn't keep my eyes open in the evenings and had to use the drops every 20 minutes. I ended up going back to contacts because apparently, they can actually protect the eyes from air that dries the eyes. You have to try different things to find what works for you. There is no magic fix.

With a history of Lyme you've probably already taken antibiotics but, if not, they can not only treat Lyme disease but, in some cases, raise platelet counts as well. In fact, ITP and Lyme may be inter-related to some degree. Unfortunately, you have to be very careful because antibiotics can also lower platelet counts even more.

Thanks for your response. Yes, I have been on antibiotics, combination/oral, many times. Most recently when I discovered the low platelets I did go back to the LLMD and was put back on antibiotics. At first platelets rose but then continued to drop and the hematologist felt that it could be the antibiotics so I stopped them.

I did have some antibody tests for babesia recently but I'm wondering, with low IgG antibodies,if a test relying on an immune response would be at all accurate. Although lyme and coinfection tests can be false negative, due to them testing only certain strains of bacteria and not others and not testing for all bands.

Bartonella or parvo virus look like other infectious triggers of ITP but I don't know if either would explain the hypersegmented neutrophils in my bone marrow biopsy.