Immunoglobulin and serum protein electrophoresis requesting is changing on 8 July 2026. Clinicians can now request immunoglobulins only or immunoglobulins and electrophoresis. This change will enable doctors to more effectively request the tests that are clinically indicated and streamline laboratory testing, delivering improved turnaround times for these tests. This change will apply to Epsom & St Helier Hospitals and their associated GPs initially, and will then be rolled out to all service users in south west London.
Immunoglobulins IgG, IgA and IgM
| Category | Immunology and PRU |
|---|---|
| Turnaround time | 2 days |
Additional information
New test codes for requesting immunoglobulins – Epsom and St Helier hospitals and GPs only
Indication for test:
– Investigation of B cell malignancy eg myeloma, lymphoma
– Investigation of immune deficiency, particularly antibody deficiency
– Investigation of autoimmune liver disease or Sjogrens syndrome
– Monitoring of patients on immunosuppressive treatment, particularly anti-CD20 therapies, to evaluate infection risk.
Please note, in adults, immunoglobulin results are always checked by the lab by protein electrophoresis the first time tested in adults, but this is not repeated if the immunoglobulin pattern remains stable.
Interpretation of results if there is no paraprotein on protein electrophoresis
| Raised IgG only | Can be seen in infection or inflammation, including some autoimmune disease. |
| Raised IgA only | Can be seen with inflammation affecting mucosal surfaces (airways, gut) and also sometimes with liver disease or some autoimmune disease. |
| Raised IgM only | This is typically seen with recent infection as part of the primary immune response. Less commonly, this can be seen in some autoimmune disease, such as primary biliary cholangitis. |
| Raised IgG and IgA | Pattern of persistent infection or inflammation. |
| Raised IgG and IgM | Pattern of persistent infection but can also be seen in some autoimmune disease. |
| Raised IgA and IgM | Pattern suggestive of recent infection affecting mucosal surfaces (airways, gut) or the liver. |
| Raised IgG, IgA and IgM | Pattern of severe infection or inflammation. |
| Low IgG only | This can be seen with some immunosuppressive treatments. The lab will test by protein electrophoresis to exclude the presence of a monoclonal protein the first time this pattern is seen. |
| Low IgA only | The IgA concentration can vary between individuals and a slightly low concentration is usually of no clinical consequence. Undetectable or very low IgA (<0.07g/L) is seen in patients with IgA deficiency, which can be associated with an increased risk of autoimmunity, gluten sensitivity and rare risk of reactions with blood products. |
| Low IgM only | A slightly low IgM concentration is very common in older patients (>55 years old) without clinical consequence, but can also be caused by some immune suppression. |
| Two or three of IgG, IgA and IgM low | Pattern of immune suppression. The lab will test by protein electrophoresis to exclude the presence of a monoclonal protein the first time this pattern is seen. |
Lab Tests Online UK
Lab Tests Online - UK is a website written by practising laboratory doctors and scientists to help you understand the many clinical laboratory tests that are used in diagnosis, monitoring and treatment of disease.
- Search Tests