When should I consider referring a patient with suspected CVID to a specialist immunologist?

Based on the provided UK guideline excerpts, there is no specific information regarding when to refer a patient with suspected common variable immunodeficiency (CVID) to a specialist immunologist ¹. The provided guidelines, titled 'Suspected cancer: recognition and referral', focus on symptoms and referral pathways for various types of suspected cancer, not primary immunodeficiencies ¹.

However, some symptoms that might be present in a patient with suspected CVID, such as unexplained and persistent or recurrent infection, lymphadenopathy, or splenomegaly, are discussed within these guidelines in the context of suspected cancer [1. 10. 1, 1. 10. 3, 1. 10. 7, 1. 10. 8].

• For adults with unexplained and persistent or recurrent infection, a very urgent full blood count (within 48 hours) should be considered for suspected leukaemia [1. 10. 1].
• For children and young people with generalised lymphadenopathy, a very urgent full blood count (within 48 hours) should be offered for suspected leukaemia [1. 10. 3].
• For adults with unexplained splenomegaly accompanied by night sweats or pruritus, a suspected cancer pathway referral should be considered for non-Hodgkin's lymphoma [1. 10. 7].
• For adults with unexplained lymphadenopathy accompanied by fever, night sweats, or pruritus, a suspected cancer pathway referral should be considered for Hodgkin's lymphoma or non-Hodgkin's lymphoma [1. 10. 9].
• For children and young people with unexplained lymphadenopathy or splenomegaly accompanied by night sweats, pruritus, or weight loss, a very urgent referral (for an appointment within 48 hours) for specialist assessment should be considered for suspected non-Hodgkin's lymphoma or Hodgkin's lymphoma [1. 10. 8, 1. 10. 10].

When considering any referral, associated symptoms such as fever, night sweats, shortness of breath, pruritus, or weight loss should be taken into account [1. 10. 8, 1. 10. 10].