What are the referral criteria for a specialist immunology assessment in cases of suspected primary immunodeficiency?

Referral criteria for specialist immunology assessment in suspected primary immunodeficiency include:

• Recurrent, unusual, or severe infections: Patients presenting with frequent, severe, or unusual infections that are not explained by other causes should be considered for referral.
• Family history: A family history of primary immunodeficiency or related conditions supports referral.
• Failure to thrive or poor growth in children: This may indicate an underlying immunodeficiency requiring specialist assessment.
• Unexplained lymphadenopathy, splenomegaly, or hepatosplenomegaly: Particularly if persistent and unexplained, these signs warrant specialist evaluation.
• Autoimmune manifestations or unusual inflammatory conditions: These may be associated with primary immunodeficiency and justify referral.
• Laboratory abnormalities: Persistent abnormalities such as low immunoglobulin levels, abnormal white cell counts, or poor vaccine responses should prompt referral.

Referral should be made to a specialist immunology service for comprehensive assessment, diagnosis, and management planning.

Note: The provided UK guideline excerpts do not explicitly detail referral criteria for primary immunodeficiency; however, these criteria are consistent with standard UK clinical practice and immunology referral pathways. The excerpts focus primarily on suspected cancer referrals and do not cover immunology-specific referral criteria ¹.