> Dear collegue, > the case you presented seems to show an increase in neutrophils. The > abslolute lymph count seems to be 2250 per µl. 60% CD19 gives ca. 1300 B > cells per µl that is above normal. T cells seem to be at the lower limit > or less. > Immunoglobulin levels in gram per liter are above normal, but you didn“t > gave units. > What is the clinical presentation? Fever, lymph nodes, spleen, time > course, weight loss? Bacterial infections may also direct towards > neutrophil disorders (if immunoglobulins are high). > What is the morphology (smear)? Carefully review a complete slide. > In our CVIDs we had no increase in B cells. So lymphoma needs to be > excluded even the probability is not high. > The kappa lambda (if its polyclonal) may be negative on some immature B > cells, that“s normal. > The rest of B markers, if expressed at normal densities, are useful for > NHL but do not help for CVID. > IgM, IgD and IgG on CD19/20 and T cell activation tests (skin and LTT) may > help for CVID to show maturational disturbances. IgG subclasses help > further to testify CVID, where immunoglobulins are the strongest > arguments. > Because of the low frequency it is also beyond our lab tests to look for > defects in receptor chains (eg. Il-2 etc). The CVIDs are diverse and > require broad panels of molecular genetic tests. > It may be worthwile from a clinical point of view to look for chronic > viral infections as they give similar pictures (igs being mostly elevated) > or might persist and worsen pictures of CVID. The CD4/8 ratio argues > against several ones but not against hepatitis and others. > Is HLA-DR on B cells normal (bare lymphocyte syndrome)? Unlike stated in > textbooks you find inborn IDs even in young adults. Eg. we just had a > Chediak Higashi Syndrome in a 27 year old women. > I hope this helped a little bit to solve your problem. > Regards > Thomas Nebe > > Dr.med. C. Thomas Nebe > Universitaetsklinikum Mannheim > Institut für Klinische Chemie > Theodor-Kutzer-Ufer 1-3 > D-68167 Mannheim > Tel. +49 621 383-3485 > FAX +49 621 383-3819 > thomas.nebe@ikc.ma.uni-heidelberg.de > PSE 75-1445 >
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