From the Guidelines
Low globulin levels, specifically hypoglobulinemia, indicate a deficiency in certain proteins crucial for immune function, blood clotting, and other bodily processes, and the most recent evidence suggests that treatment should focus on addressing the underlying cause rather than the globulin level itself 1.
Causes and Implications
The condition can result from various underlying causes, including liver disease, kidney disease, malnutrition, protein-losing enteropathy, or certain genetic disorders. Low globulin may lead to increased susceptibility to infections, poor wound healing, and bleeding problems.
- Liver disease: Managing the condition becomes the priority.
- Kidney disease: Treatment focuses on addressing the underlying kidney issue.
- Malnutrition: Increasing protein intake through diet or supplements may help.
- Protein-losing enteropathy: Addressing the underlying gastrointestinal issue is crucial.
- Genetic disorders: Treatment depends on the specific disorder.
Diagnosis and Management
Patients with low globulin should work with their healthcare provider to identify the cause through additional testing, which may include:
- Comprehensive metabolic panels
- Protein electrophoresis
- Immunoglobulin level tests Regular monitoring is important, especially for those with chronic conditions affecting protein levels. According to the most recent study 1, the principles of management of hypogammaglobulinemia should follow those for antibody deficiency, and IgG therapy and antibiotics are the mainstays of therapy for certain deficiencies, such as AID and UNG deficiencies. In some cases, IgG replacement therapy may be necessary, particularly during seasons when respiratory illnesses are more frequent 1. It is essential to note that the definitive diagnosis of transient hypogammaglobulinemia of infancy (THI) can only be made after IgG levels have corrected, and most children with THI spontaneously recover their IgG values and have a benign clinical course 1.
From the Research
Definition and Causes of Low Globulin Levels
- Low globulin levels, also known as hypoglobulinemia, can be caused by various factors, including primary and secondary immune deficiency, multiple myeloma, and other conditions 2, 3, 4.
- Hypogammaglobulinemia, a type of hypoglobulinemia, can be caused by decreased maternal transfer or production, increased loss of immunoglobulins, or destruction/suppression of immunoglobulins 4.
Detection and Screening of Low Globulin Levels
- Calculated globulin (CG) can be used as a screening test for antibody deficiency, with a cut-off value of <18 g/L or <20 g/L, depending on the study 3, 5.
- Screening for low globulin levels can detect patients with primary and secondary immune deficiency, multiple myeloma, and other conditions, allowing for early intervention and treatment 2, 3.
- The use of CG as a screening test can help reduce diagnostic delays and improve treatment outcomes for patients with antibody deficiency 3, 5.
Clinical Implications of Low Globulin Levels
- Low globulin levels can be associated with increased morbidity and mortality, particularly if left untreated or undertreated 2, 6.
- Patients with low globulin levels may require immunoglobulin replacement therapy, supportive care, or other treatments, depending on the underlying cause and condition of the patient 4, 5.
- Clinicians should be aware of the potential causes and consequences of low globulin levels and use screening tests, such as CG, to detect and manage these conditions effectively 2, 3, 5.