Image-based modeling and scoring of Howell-Jolly Bodies in human erythrocytes

„Hyposplenie“, eine weitgehend unerkannte Immunschwäche: Ist die Sonografie hilfreich?

Das Immundefizienzsyndrom der funktionellen Hyposplenie/Asplenie ist weitgehend unerkannt. Die Goldstandardprozedur stellt die Technetium-99m-Szintigrafie von hitzedenaturierten Erythrozyten (TSZ) sowie der Nachweis von pitted Erythrozyten oder Howell-Jolly-Körperchen (HJB) dar. Erste Arbeiten weisen darauf hin, dass dieses Krankheitsbild mit einer kleinen Milz assoziiert ist. Ziel der vorliegenden Übersicht ist es, den Stellenwert der B-Bild-Sonografie und der kontrastunterstützten Sonografie bei der Immunschwäche der Hyposplenie darzustellen.

Diagnostic Modalities in Primary Immunodeficiency

As the field of inborn errors of immunity expands, providers continually update and fine-tune their diagnostic approach and selection of testing modalities to increase diagnostic accuracy. Here, we first describe a mechanistic consideration of laboratory testing, highlighting both benefits and drawbacks of currently clinically available testing modalities. Next, we provide methods in evaluation of patients presenting with concern for inborn errors of immunity as defined by the International Union of Immunological Societies 2019 phenotypic categories: primary antibody deficiencies, cellular and humoral immune deficiency, disorders of the innate immune system, and syndrome-associated and primary immune regulation disorders (PIRDs). Using the suggested approach in this paper as a roadmap highlights the importance of thorough history taking and physical examination as the foundation to guide further diagnostic tests. This is followed by enumeration and functional testing. Finally, to determine the underlying molecular etiology-specific genetic panels, chromosomal microarrays, and broad genetic testing (whole exome sequencing or whole genome sequencing) are available.