The innate and adaptive systems are not mutually exclusive and there is communication between all aspects of the immune system to enable the whole cascade to work effectively. This is one of the reasons that it is particularly difficult to identify the specific area of defect in immune deficiency and can lead to problems in diagnosing and managing these conditions.

How could collaborative care assist in the diagnosis of a patient with immunodeficiency and which other healthcare professionals will be involved in the process?

Collaborative care is essential in the diagnosis of immunodeficiency. The initial symptoms are most likely to be reported to a GP or practice nurse. The patient is then referred to and reviewed by a Consultant Immunologist or Immunology Clinical Nurse Specialist. Specialised tests will be performed, often requiring the immune system to be ‘tested’ using vaccinations – the specialist centre will usually request assistance from the GP/practice nurse with ongoing investigations (vaccinations and/or post vaccination blood tests) – this process is described later in the chapter. The immunology laboratory staff play an important role in diagnosing immunodeficiency as highly specialised tests are required to identify which part of the immune system is malfunctioning. For example, they can measure the number and function of immune cells and distinguishing between the naïve and mature cells. This allows an accurate picture of the immune system to be used for diagnosis.

How could you assist the patient with understanding their diagnosis?

In order to explain the diagnosis, you must first understand the function of the cells of the immune system. You can use this knowledge to explain how the immune system is working (or not working) to the patient. You should use language and concepts that are at a level appropriate to the patient. The immune system is complicated for most lay people to understand but if you can relate the function of the cells to the symptoms they are experiencing, a greater comprehension of their diagnosis will follow.