Tuesday 12 December 2017

A common immunodeficiency and preparing for a baby

Ask the GP...

Gastrointestinal upset can be associated with IgA deficiency
Gastrointestinal upset can be associated with IgA deficiency

Nina Byrnes

Our GP has advice on protein IgA deficiency and the Maternity and Infant scheme.

Question: I had some blood tests recently and my GP told me I am deficient in a protein called IgA. She told me not to worry. Is there anything I need to know?

Dr Nina replies: Deficiencies in the immune system may be characterised by low antibody levels, defects in the antibodies or defects in the other cells and proteins of the immune system. A functioning immune systems is important to help the body fight off infections. The most common immunodeficiency is selective IgA deficiency. Low levels of this antibody can make it more difficult for the body to fight off bacteria and viruses.

IgA antibodies are found in the surfaces of the body that come in contact with the outside. Common sites are the lining of the eyes, nose, mouth throat, airways, gut and genitals. IgA antibodies are found in the secretions found in these areas and they act as an early weapon against invading infection.

IgA deficiency is often inherited. It is relatively common being found in approximately one in 700 people of European origin.

Most people with selective IgA deficiency have no symptoms. Others may notice an increased tendency to ear, nose, throat and other respiratory infections. Chronic diarrhoea and gastrointestinal upset can be associated.

Allergies may be more common occurring in about 10pc to 15pc of those affected. Autoimmune conditions may also occur in 25pc to 35pc of those with IgA deficiency.

In selective IgA deficiency the rest of the immune system is functioning correctly so, although early barriers to infection may be weaker, the rest of the response is intact.

IgA levels sometimes increase themselves over time. If you are having recurrent unexplained infections your doctor may check your IgA levels or it may be noted on other test such as that for coeliac disease.

In the majority of cases no treatment is required. However if you develop an infection your doctor is more likely to prescribe an antibiotic to cover any serious immune assault. Longer courses may also be required.

It is important to inform health professionals if you have this condition. Those with a complete abscess of IgA may have a life-threatening reaction if a transfusion of blood or blood products is required.

The outlook is good overall. IgA deficiency is considered a mild form of immunodeficiency. Most of those affected remain otherwise healthy.

Question: I am expecting my first baby. I have been advised to register with a GP for the Maternity and Infant scheme as it will provide free GP care. Can you explain how this scheme works? How do I sign up?

Dr Nina replies: The maternity and infant scheme was introduced into Ireland in 1954 to provide free GP care to pregnant mothers and their newborn babies. This scheme was initially proposed by Minister for health Noel Browne a number of years earlier.

Noel Browne was a Trinity graduate. He wanted to provide free medical care to all mothers and children up to age 16. His proposal was seen as too controversial by both church and state and he resigned without seeing the scheme initiated. Our current scheme is a modified version of what he proposed and covers expectant mothers for pregnancy care and offers baby check at two and six weeks post-natal.

The scheme is available to all pregnant mothers who are ordinarily resident in Ireland. To sign up you should visit your GP of choice. The first visit usually occurs before 12 weeks of pregnancy. Your GP will give you a form to sign. This should cover the initial visit and will cover a further five routine pregnancy visits alternating between the hospital and GP. A two and six-week post-natal check for the baby and a six-week post natal check for the mother are also covered. Up to five extra visits may be covered if they relate directly to the pregnancy and are specifically required.

The care you receive from your GP is the same whether you are attending the hospital as a public, semi-private or private patient.

Signing up for the scheme is a great way to become familiar with your GP practice of choice. You get to know the doctors and midwife and these can be a great source of advice and support throughout pregnancy and beyond. This is usually very welcome at such an exciting time in your life.

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