We may have a case of misdiagnosed Bruton's or? The patient has carried this diagnosis for many years. However, he has 4% CD20+ cells for an absolute count of 110 cells/ microliter. In addition, he has elevated serum IgM levels, but almost no IgG and A. It seems that hyper IgM would be more likely. I'd like to hear opinions from labs who assay for these immunodeficiencies. Is assaying for btk mutations to definitively rule out Bruton's worth it? I understand that some Bruton's can be "leaky" and may have a few B cells, but this patient is low normal for B cells and the elevated IgM seems to rule out Bruton's already. Is this true? Or would you pursue the hyper IgM diagnosis. If so, what assays are definitive? Thank you for your help in advance. Best regards, Tony Bakke Antony C. Bakke, Ph.D. Director, Special Immunology and Flow Cytometry Oregon Health Sciences University Portland, OR (503) 494-4687
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