[CIS PIDD] ? SCID newborn

[Notarangelo, Luigi]

Dear Joe:

This is very unlikely to be reticular dysgenesis, because RD patients typically have an ANC of 0. However, if needed, I can help with genetic testing for AK2 (but would suggest to postpone this, because RD is unlikely). ADA deficiency is very very possible. Extreme lymphopenia (often involving all subsets) is very common in ADA def. I would recommend immediate testing for this. Mike Hershfield at Duke can be very helpful as he would look at ADA and dAXP levels and could also search for mutation.  Does she have elevated LFTs?
Although she is obviously extremely lymphopenic, it would be important to know what those 84 lymphs are.

Best,

Gigi Notarangelo

Sent from my iPhone

Luigi D. Notarangelo, MD
Jeffrey Modell Chair of Pediatric Immunology Research
Division of Immunology
Children's Hospital Boston
Professor of Pediatrics and Pathology
Harvard Medical School
Karp Building, Room 10217
1 Blackfan Circle
Boston, MA 02115

Tel: (617)-919-2276
Fax: (617)-730-0709


On Sep 28, 2012, at 7:51 PM, "Church, Joseph" <JChurch at chla.usc.edu<mailto:JChurch at chla.usc.edu>> wrote:


Colleagues:

I will be seeing a patient who was identified by our SCID newborn screening program.

Currently 4 weeks of age, 33w gestational age twin B (likely not identical).  No report of rash, adenopathy or organomegaly.


·         Low TREC screen (4 copies vs normal of >25)

·         CBC:
            Normal hematocrit and hemoglobin.
            Normal platelet count.
           WBC 1,400/mcL - 34% neutrophils, 6% lymphocytes, 20% monocytes, 34% eosinophils.

·         Flow cytometry pending.

Since the absolute lymphocyte count is so low (84/mcL), I don't think the flow will help much.

Although reticular dysgenesis is associated with normal red blood cells and platelets, I don't think that the patient's monocyte and eosinophil counts are consistent with this diagnosis.

Can ADA deficiency present like this?

What other PIDD(s) might present with both profound lymphopenia and neutropenia in a female?

Thank you for your help.

Joe Church
Children's Hospital Los Angeles




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