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Was he already on steroid treatments when this was drawn? For one thing... It isn't considered significant unless the IGM is below 16.5 in children. It is part of the immune system and it is for fighting blood infections. It is more concerning if it is high but less than 16.5 consistently is concerning as well. The "ref ranges" are the normal ranges so the first two were 100% normal. It looks like the ref ranges are for adults as well hence the 16.5 being the worry mark for children. Normal for children is 35-290 with no concern if it is over 20 as it will fluctuate with a preventative response to an illness. (It fights germs before they make you sick so he won't look sick even if he is fighting something.) I hope that helps.