Specialists

1. Pediatricians or general practitioners refer children with suspected of primary immunodeficiency (PID further) to a medical immunologist in the presence of two or more symptoms listed below:
   1. 1.1. Availability of PID patients in the family.
   2. 1.2. The presence of the death of a young child with clinical infection in family history.
   3. 1.3. Frequent upper respiratory tract infection (preschoolers - 8 or more times during a year, high school students - 5-6 times a year).
   4. 1.4. Lack of effect or minimal effect on the long-term antibiotic therapy (over two months or more).
   5. 1.5. Recurring severe purulent or fungal infections of the skin or internal organs.
   6. 1.6. Purulent inflammation of the paranasal sinuses or otitis 2 or more times during a year.
   7. 1.7. Pneumonia (radiologically confirmed) 2 or more times during a year.
   8. 1.8. Recurrent candidiasis (thrush) or aphthous stomatitis in the age of 1 year.
   9. 1.9. More than two serious infectious processes in the anamnesis (sepsis, osteomyelitis, meningitis, lingering omphalitis, tuberculosis).
   10. 1.10. Backlog of a child under the age of 1 year in weight and height.
   11. 1.11. Resistant, responds poorly to treatment and recurrent diarrhea.
   12. 1.12. The presence of ataxia and telangiectasias.
   13. 1.13. A common atopic dermatitis, severe continuously relapsing course.
   14. 1.14. Recurrent swelling of subcutaneous tissue and mucosal infectious etiology.
2. Consultation of children with suspected PID is carried out at the regional (city) level by immunologists, who provide health care for children up to 18 years, in the organization of health care and in the manner, which is established by the order of the health department of the regional executive committee (the Health Committee of Minsk Municipal Executive Committee).
3. For the consultation with an immunologist at the regional (city) level a pediatrician (a general practitioner) provides in the prescribed manner: the direction of a pediatrician or general practitioner;

an extract from the history of the development of the child.

4. Immunologists of regional centers and of Minsk carried out a consultation and inspection of the patient (considering opportunities of the region), which includes the following definition of immunological parameters:
   1. The content of immunoglobulins in serum of peripheral blood (immunoglobulin G, M, A and E).
   2. The content of lymphocyte subpopulations by flow cytometry (T-lymphocytes (CD3), B-lymphocytes (CD19), T-helper (CD4), cytotoxic T lymphocytes (CD8), natural killer (CD16-56) ( for patients of Minsk region this type of the research carried out in SI "Centre of Pediatric Oncology, Hematology and Immunology").
   3. Functional activity of phagocytic cells (ICT test, phagocytosis of latex particles and bacteria).
   4. The functional activity of the complement system (hemolytic activity of the classical pathway - CH50).
   5. Proteinogramma with the evaluation of gamma protein fraction.
5. The direction to the consultation of children with suspected primary immunodeficiency in SI "Centre of Pediatric Oncology, Hematology and Immunology," performed by immunologists in the presence of the following changes in an immunogram, in their absence - in consultation with the State Institution "Centre of Pediatric Oncology, Hematology and Immunology":
   1. Decrease level of immunoglobulin classes G, M and A by more than 2 times the age norm; reduction or complete absence of gamma protein fraction in proteinogram.
   2. Increased levels of immunoglobulin M by more than 2 times the age norm.
   3. Elevated immunoglobulin E 1000 IU / ml.
   4. Decrease (more than 2-fold) or absence of T-lymphocytes and their subsets, B cells, natural killer cells.
   5. Decrease or absence of functional activity of phagocytic cells.
   6. Reduction or complete lack of activity of the complement system.
6. The final diagnosis of primary immunodeficiency is established after consultation and examination in SI "Centre of pediatric oncology, hematology and immunology."
7. Children with a suspected of primary immunodeficiency come for consultation in the SI "Centre of Pediatric Oncology, Hematology and Immunology" by appointment by calling (017) 265-40-85, (017) 265-25-18.
8. For consultation in SI "Centre of Pediatric Oncology, Hematology and Immunology," the patient in the prescribed manner is issued:

by immunologist - direction with the results of immunological examination;

pediatrician (GP) at the residence (residence of the child) - an extract from the history of the development of the child.

The legal representatives of the child are informed of the need to carry a birth certificate (passport) of the Child and the passport of one of the legal representatives in the presence of direction.

9. Diagnostics and treatment of children with PID based on the SI "Centre of Pediatric Oncology, Hematology and Immunology," conducted in accordance with protocols approved by the clinical diagnosis and treatment.
10. Children with confirmed primary immunodeficiency do not require hospitalization at the SI "Centre of Pediatric Oncology, Hematology and Immunology" are under medical observation of an immunologist at the place of residence (stay).
11. On reaching the age of 18 patients with confirmed primary immunodeficiency are transferred to a dispensary observation to the SI "Centre of Radiation Medicine and Human Ecology."

© 2017 Belarussian Center for Primary Immunodeficiency

Belarus, Minsk district, Borovlyany, Frunzenstreet, 43