[CIS PIDD] [cis-pidd] quick question

[Anthony Hayward]

Your best bet would be Luigi Notarangelo at Boston Children's Hospital. I'm
at Hasbro Children's Hospital in Providence, Rhode Island, and would be
happy to help - but Luigi is closer.

Anthony Hayward

-----Original Message-----
From: Bodo Grimbacher [mailto:bodo.grimbacher at uniklinik-freiburg.de] 
Sent: Wednesday, June 10, 2015 2:28 PM
To: CIS-PIDD
Subject: [cis-pidd] quick question

Dear all,
Is there a PID specialist near Burlington, MA 01805?
A patient with rec. candidiasis requests to be seen...
Thanks, Bodo
****************************************
Univ.-Prof. Dr. med. B. Grimbacher
 
Scientific-Director
CCI-Center for Chronic Immunodeficiency
UNIVERSITÄTSKLINIKUM FREIBURG
Tel.: 0761 270-77731  Fax: -77744
Engesserstraße 4, 79108 Freiburg
bodo.grimbacher at uniklinik-freiburg.de
www.uniklinik-freiburg.de/cci




Am 09/06/15 20:13 schrieb "Dr. Jan Rohr" unter
<jan.rohr at uniklinik-freiburg.de>:

>Dear Rafael,
>
>I am not familiar with the gating strategy of your lab, but a reference 
>range down to 15% CD45RA+ cells in a 22 months old child seems pretty 
>low to me. In our lab the patient's value of 20% CD45RA would be 
>considered a pathologically low number at this age and thus warrant 
>further investigations. What is also somewhat odd is that the 
>percentages of CD45RA+ and CD45RO+ cells do not add to 100% - what do 
>the remaining cell express if they are neither positive for CD45RA nor 
>for CD45RO ?
>
>May be worth to take a close look at the FACS plots.
>
>Kind regards,
>
>Jan
>
>
>
>Zitat von Rafael Firszt <Rafael.Firszt at hsc.utah.edu>:
>
>>
>>
>> I have a 22 month old with persistently borderline -mildly low CD8 
>>counts  Clinically doing very well.  Very mild URI's only.  Developing  
>>normally and growing well.
>> Tolerated Live viral vaccines.
>> He was initially identified by newborn screen with low TRECS  His 
>>immune parameters are below.
>> He has normal CD45RA
>>
>> Ref. Range
>>
>> Units
>>
>> 06/05/15
>> 12:10 *
>>
>> 08/13/14
>> 12:15 [https://help2-lp.co.ihc.com/ResultsReview/images/note.gif] *
>>
>> 05/07/14
>> 12:20
>>
>> 01/21/14
>> 16:40 [https://help2-lp.co.ihc.com/ResultsReview/images/note.gif]
>>
>> Test Status
>>
>> Final
>>
>> Final
>>
>> Final
>>
>> Final
>>
>> % CD4 
>> [https://help2-lp.co.ihc.com/ResultsReview/images/infoTrans.gif]
>>
>> 31-54
>>
>> %
>>
>> 30 L
>>
>> 30 L
>>
>> * 24 L
>>
>> * 25 L
>>
>> CD4, Abs Count
>> [https://help2-lp.co.ihc.com/ResultsReview/images/infoTrans.gif]
>>
>> 1020-3600
>>
>> cells/uL
>>
>> 924 L
>>
>> 1096
>>
>> * 1002 L
>>
>> * 989 L
>>
>> % CD45RO
>>[https://help2-lp.co.ihc.com/ResultsReview/images/infoTrans.gif]
>>
>> 5-30
>>
>> %
>>
>> 11
>>
>> 7
>>
>> * 6
>>
>> * 7
>>
>> Absolute CD45RO
>> [https://help2-lp.co.ihc.com/ResultsReview/images/infoTrans.gif]
>>
>> 50-1500
>>
>> cells/uL
>>
>> 299
>>
>> 239
>>
>> * 246
>>
>> * 263
>>
>> % CD45RA
>>[https://help2-lp.co.ihc.com/ResultsReview/images/infoTrans.gif]
>>
>> 15-70
>>
>> %
>>
>> 20
>>
>> 24
>>
>> * 19
>>
>> * 20
>>
>> Absolute CD45RA
>> [https://help2-lp.co.ihc.com/ResultsReview/images/infoTrans.gif]
>>
>> 200-3400
>>
>> cells/uL
>>
>> 571
>>
>> 786
>>
>> * 810
>>
>> * 742
>>
>> CD4/CD8 Ratio   
>> [https://help2-lp.co.ihc.com/ResultsReview/images/infoTrans.gif]
>>
>> 1.17-6.62
>>
>> ratio
>>
>> 3.00
>>
>> 3.33
>>
>> * 3.00
>>
>> * 3.12
>>
>> % CD8 
>> [https://help2-lp.co.ihc.com/ResultsReview/images/infoTrans.gif]
>>
>> 16-38
>>
>> %
>>
>> 10 L
>>
>> 9 L
>>
>> * 8 L
>>
>> * 8 L
>>
>> Absolute CD8
>>[https://help2-lp.co.ihc.com/ResultsReview/images/infoTrans.gif]
>>
>> 570-2230
>>
>> cells/uL
>>
>> 292 L
>>
>> 339 L
>>
>> * 326 L
>>
>> * 329 L
>>
>> % CD3 
>> [https://help2-lp.co.ihc.com/ResultsReview/images/infoTrans.gif]
>>
>> 53-81
>>
>> %
>>
>> 43 L
>>
>> 40 L
>>
>> * 34 L
>>
>> * 34 L
>>
>> Absolute CD3
>>[https://help2-lp.co.ihc.com/ResultsReview/images/infoTrans.gif]
>>
>> 1460-5440
>>
>> cells/uL
>>
>> 1316 L
>>
>> 1483
>>
>> * 1373 L
>>
>> * 1349 L
>>
>> % CD19 
>> [https://help2-lp.co.ihc.com/ResultsReview/images/infoTrans.gif]
>>
>> 11-45
>>
>> %
>>
>> 46 H
>>
>> 47 H
>>
>> * 49 H
>>
>> * 51 H
>>
>> Absolute CD19   
>> [https://help2-lp.co.ihc.com/ResultsReview/images/infoTrans.gif]
>>
>> 430-3300
>>
>> cells/uL
>>
>> 1381
>>
>> 1725
>>
>> * 2009
>>
>> * 2051
>>
>> % Natural Killer Cells
>> [https://help2-lp.co.ihc.com/ResultsReview/images/infoTrans.gif]
>>
>> 3-19
>>
>> %
>>
>> 9
>>
>> 11
>>
>> * 15
>>
>> * 13
>>
>> Absolute Natural Killer Cells
>> [https://help2-lp.co.ihc.com/ResultsReview/images/infoTrans.gif]
>>
>> 80-340
>>
>> cells/uL
>>
>> 288
>>
>> 403 H
>>
>> * 621 H
>>
>> * 538 H
>>
>>
>>
>> In addition, he appears to have normal MHC I expression and normal NK 
>> function
>>
>> His IgG, M, A levels normal with very protective antibody titers.
>> Normal lymphocyte mitogen assays.
>>
>>
>> Should I be concerned?
>>
>>
>> Thank you for your help.
>>
>> Rafael Firszt, MD
>> University of Utah
>>
>>
>>
>>
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