[CIS PIDD] [cis-pidd] Lymphopenia 17 year-old

[Jason W. Caldwell]

For what it is worth, in these cases I like to look at CD45 RA and RO numbers too, but I start to get nervous at these absolute numbers and will usually give prophylaxis for PCP.
Jason W Caldwell MCS DO FAAAAI

Assistant Professor Internal Medicine & Pediatrics

Interim Director of Allergy/Immunology

Program Director Allergy/Immunology
Section of Pulmonary, Critical Care, Allergic and Immunological Diseases

Wake Forest School of Medicine
Medical Center Boulevard  \  Winston-Salem, NC 27157
p 336.716.0572  \  f 336.716.4734
jcaldwel at wakehealth.edu  \  WakeHealth.edu
[WFSM_color_reversed]




From: Jason Raasch [mailto:jraasch at midwestimmunology.com]
Sent: Friday, August 30, 2013 5:22 PM
To: CIS-PIDD
Subject: [cis-pidd] Lymphopenia 17 year-old




The following is a brief summary of a patient my colleague now cares for.  [I hope the text formatting is forgiving].

** THE QUESTION: What is your opinion regarding pneumocystis prophylaxis based on his flow cytometry? **

17-year-old male with a history of congenital heart defect and cardiac repair at birth.  Thymus was likely removed with 1st surgery.

Clinically doing very well.  Mild psoriasis. No significant infectious history.  Immunoglobulin levels are normal, CD 19 absolute and percentages  are normal. FISH analysis of DiGeorge was negative for 22q11 deletion at birth and has not been repeated.

He has been noted to have lymphocytopenia with CD3 positive T cells consistently less than 500.  His recent CD3CD4 numbers have fallen due to a decrease in his absolute lymphocyte count and are reported as follows:




July 2013


June 2012


CD3


46%  299/uL


43%   414/uL


CD3CD4


34%  221/uL


30%   289/uL


CD3CD8


19%  124/uL


24%   231/uL


CD4/CD8 ratio


3.00


2.42




CONVERSATIONS ABOUT THIS TOPIC SEEM TO GO AROUND AND AROUND.  JUST LIKE TO HEAR HOW SOME OF YOU MIGHT APPROACH THIS QUESTION.



THANKS.



-J



Jason Raasch, MD

Midwest Immunology Clinic
15700 37th Ave N, Ste 110
Plymouth, MN 55446

TEL: (763) 577-0008
FAX: (763) 577-0192

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