[CIS-PAGID] Leucopenia with no monocytes and low B cells

[Eleonora Gambineri]

Dear all,

I would like your inputs on the case below:

8y/o male

Past medical history:

·         recurrent otitis and pharyngitis until adenoidectomy (4 yo)
·         4yo: chickenpox with normal course
·         Since 6yo: episodes of aphthous stomatitis every2-3 months,  
sometimes associated with fever.
·         August 2010: CBC -> leucopenia

Laboratory work up:

October 2010:

·         WBC: 3300/μL, Neutrophils 26.6% (absolute value: 877/ μL)  
Monocyte 0%
·         CMV, EBV, Toxoplasmosis: negative
·         Celiac disease screening: negative
·         ANA, ENA, pANCA: negative
·         Anti-neutrophils Ab: negative
·         Immunoglobulins: within normal range
·         Lymphocyte subsets:  B cells 9% (absolute value 240/ μL), T  
cells CD3+ 87% (av: 2310), T cells CD3+CD4+ 48% (av: 1270/ μL), T  
cells CD3+CD8+ 22% (av: 580/ μL), NK cells 4% (110/ μL)

Genuary 2011

·         Bone Marrow Aspiration:  hypocellular for the age of the  
patient, dysmyelopoiesis

May 2011: fever + arthritis

·         WBC: 3200/μL, Neutrophils 21.7% (absolute value: 690/μL)  
Monocyte 0%, Hemoglobin 10.3 g/dl, platelet  153000/μL
·         Parvovirus B19 blood PCR: positive
·         Lymphocyte subsets:  B cells 7% (absolute value 176/ μL), T  
cells CD3+ 92% (av: 2480/ μL), T cells CD3+CD4+ 54% (av: 1457/ μL), T  
cells CD3+CD8+ 27% (av: 742/ μL), NK cells 1% (39/ μL)
·         CD3+TCRαβ+CD4-CD8- (DNT cells): 1,3% of CD3+lymphocyte

Bone Marrow Aspiration:

·         Normal cellularity with decreased myeloid series
·         TERC gene and TINF2 gene: no mutations
·         FISH chromosome 7, 8 LSI 21 (21q22.13-q22.2): no chromosomal  
abnormalities
·         Parvovirus  B19 PCR: positive

July 2011:

·         WBC: 2470/μL, Neutrophils 22.8% (absolute value: 563/μL)  
Monocyte 0.4%, Hemoglobin 13 g/dl, platelet  138000/μL
·         Parvovirus B19 blood PCR: negative
·         Clinically well

  Currently ongoing: FAS induced apoptosis assay, B memory cell  
phenotype, specific antibodies (i.e. anti-pneumococcus, anti-tetanus)



Any thoughts/suggestions is really appreciated!

Thanks.

BEst wishes,

Eleonora


*******************************************************************
Dott.ssa Eleonora Gambineri
Ricercatore Universitario

Universita' degli Studi di Firenze, Dipartimento di Scienze per la  
Salute della Donna e del Bambino
Ospedale Pediatrico "Anna Meyer", Dipartimento di Oncoematologia-Unità  
TMO
Viale Gaetano Pieraccini, 24
50139 FIRENZE
Tel 055 5662405 (ufficio)
        055 5662606 (reparto T.M.O.)
Fax 055 4221012
e-mail: eleonora.gambineri at unifi.it; e.gambineri at meyer.it

Eleonora Gambineri, MD
Researcher/Assistant Professor

University of Florence, Department of Sciences for Woman and Child's  
Health
"Anna Meyer" Children's Hospital, Department of Haem/Onc-BMT Unit
Viale Gaetano Pieraccini, 24
50139 FIRENZE
ITALY
Tel +39 055 5662405 (office)
        +39 055 5662606 (BMT Unit)
Fax +39 055 4221012
e-mail: eleonora.gambineri at unifi.it; e.gambineri at meyer.it
********************************************************************





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