[CIS PIDD] [cis-pidd] Lymphopenia after thoracic duct ligation
Nacho Gonzalez
nachgonzalez at gmail.com
Wed Jun 12 12:38:05 EDT 2013
Agree with Dr. Church,
Our cardiac surgeons "always" remove the thymus after sternotomy. They say
that surgery is easier for them. Here in Madrid we are a referral centre
for congenital cardiac surgery and we follow these thymectomized patients,
so I am pretty sure that they still remove the thymus completely
Regards,
Luis
2013/6/12 Church, Joseph <JChurch at chla.usc.edu>
> If the baby had open heart surgery for IAA it is likely that a
> thymectomy was done by the surgeons. This will result in persistently low
> TREC.****
>
> ** **
>
> J Church****
>
> Children’s Hospital Los Angeles****
>
> ** **
>
> *From:* Richard Wasserman [mailto:drrichwasserman at gmail.com]
> *Sent:* Wednesday, June 12, 2013 9:23 AM
>
> *To:* CIS-PIDD
> *Subject:* [cis-pidd] Lymphopenia after thoracic duct ligation****
>
> ** **
>
> Colleagues,****
>
> Two month old male with abnormal newborn TREC screen. Newborn screen on
> day of life 2 was normal. On day of life 4, presented with an interrupted
> aortic arch, AP window and ASD. Initial CBC showed a white count of 16,700,
> ALC 4800. IAA repair on day 8. Post-op chylothorax required chemical
> pleurodesis on DOL 30 but chylous drainage persisted and thoracic duct
> ligation was performed on DOL 41. From DOL 9 - 41 ALC ranged from 574 to
> 1782.****
>
> Repeat newborn screen showed very low TREC on DOL 16. On discharge at DOL
> 51, the patient’s ALC was 3332. Follow up CBC on DOL 58 showed an ALC of
> 8692/mm3. Additionally, chromosomal microarray and FISH for DiGeorge
> Syndrome were normal.****
>
> There have been no significant infections There is no family history
> suggestive of immunodeficiency.****
>
> The abnormal TREC was felt to be related to the lymphocytopenia stemming
> from his chylothorax. We saw him at 63 days of life and appeared in good
> heath. The third newborn screen is pending. Studies are shown. Mitogen
> stimulation is pending.****
>
> *T&B Lymphocyte/Nat Killer (T cell subsets)*****
>
> Abs.CD19+ Lymphs H 3845 (/uL) 600-1900 ****
>
> % CD19+ Lymphs H 69.9 (%) 4.0-26.0 ***
> *
>
> Absolute CD 3 L 787 (/uL) 2300-7000
> ****
>
> % CD 3 Pos. Lymph. L 14.3 (%) 60.0-85.0 **
> **
>
> Absolute CD 4 Helper L 561 (/uL) 1700-5300 *
> ***
>
> % CD 4 Pos. Lymph. L 10.2 (%) 41.0-68.0 **
> **
>
> Abs. CD 8 Suppressor L 226 (/uL) 400-1700 ***
> *
>
> % CD 8 Pos. Lymph. L 4.1 (%) 9.0-23.0 **
> **
>
> CD4/CD8 Ratio 2.49
> 0.92-3.72 ****
>
> Ab NK (CD56/16) 726 (/uL) 200-1400 *
> ***
>
> % NK (CD56/16) 13.2 (%) 3.0-23.0 *
> ***
>
> ****
>
> WBC 10.9 (x10E3/uL)
> 5.0-12.4 ****
>
> RBC 3.75 (x10E6/uL)
> 2.72-4.84 ****
>
> Hemoglobin 10.3 (g/dL)
> 8.8-14.3 ****
>
> Hematocrit 31.0 (%)
> 26.6-41.0 ****
>
> MCV 83 (fL)
> 81-97 ****
>
> MCH 27.5 (pg)
> 27.1-34.0 ****
>
> MCHC 33.2 (g/dL)
> 31.9-36.0 ****
>
> RDW 16.0 (%)
> 12.2-16.4 ****
>
> Platelets 519 (x10E3/uL)
> 150-579 ****
>
> Neutrophils 23 (%)
> 10-42 ****
>
> Lymphs 51 (%)
> 3-11 ****
>
> Eos H 7 (%)
> 0-5 ****
>
> Basos 0 (%)
> 0-2 ****
>
> Neutrophils (Absolute) 2.5 (x10E3/uL) 0.6-4.4****
>
> Lymphs (Absolute) 5.5 (x10E3/uL) 1.4-8.6 ***
> *
>
> Monocytes(Absolute) H 2.1 (x10E3/uL) 0.2-1.1 ****
>
> Eos (Absolute) H 0.8 (x10E3/uL) 0.0-0.4 **
> **
>
> *Immunoglobulin M, Qn, Serum* 24 (mg/dL) 0-145****
>
> Do you think we can account for the T cell lymphopenia and B cell
> lymphocytosis by the duct ligation alone? ****
>
> ** **
>
> Thanks,****
>
> --
> Richard L. Wasserman, MD, PhD
> DallasAllergyImmunology
> 7777 Forest Lane, Suite B-332
> Dallas, Texas 75230
> Office (972) 566-7788
> Fax (972) 566-8837
> Cell (214) 697-7211 ****
>
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