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Amatuni GS, Sciortino S, Currier RJ, Naides SJ, Church JA, Puck JM. Reference intervals for lymphocyte subsets in preterm and term neonates without immune defects. J Allergy Clin Immunol 2019; 144:1674-1683. [PMID: 31220471 DOI: 10.1016/j.jaci.2019.05.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/28/2019] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND In 6.5 years of newborn screening for severe combined immunodeficiency in California, 3,252,156 infants had DNA from dried blood spots (DBSs) assayed for T-cell receptor excision circles. Infants with T-cell receptor excision circle values of less than a designated cutoff on a single DBS, 2 DBS samples with insufficient PCR amplification, or known genetic risk of immunodeficiency had peripheral blood complete blood counts and lymphocyte subsets assayed in a single flow cytometry laboratory. Cases in which immune defects were ruled out were available for analysis. OBJECTIVE We sought to determine reference intervals for lymphocyte subsets in racially/ethnically diverse preterm and term newborns who proved to be unaffected by any T-lymphopenic immune disorder. METHODS Effective gestational age (GA) was defined as GA at birth plus postnatal age at the time of sample collection. After determining exclusion criteria, we analyzed demographic and clinical information, complete and differential white blood cell counts, and lymphocyte subsets for 301 infants, with serial measurements for 33 infants. Lymphocyte subset measurements included total T cells, helper and cytotoxic T-cell subsets, naive and memory phenotype of each T-cell subset, B cells, and natural killer cells. RESULTS Reference intervals were generated for absolute numbers and lymphocyte subsets from infants with effective GAs of 22 to 52 weeks. Sex and ethnicity were not significant determinants of lymphocyte subset counts in this population. Lymphocyte counts increased postnatally. CONCLUSION This study provides a baseline for interpreting comprehensive lymphocyte data in preterm and term infants, aiding clinicians to determine which newborns require further evaluations for immunodeficiency.
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Affiliation(s)
- George S Amatuni
- Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, Calif; Stem Cell Institute, Department of Cell Biology, Einstein College of Medicine, Bronx, NY
| | - Stanley Sciortino
- Genetic Disease Screening Program, California Department of Public Health, Richmond, Calif
| | - Robert J Currier
- Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, Calif
| | - Stanley J Naides
- Immunology Department, Quest Diagnostics Nichols Institute, San Juan Capistrano, Calif
| | - Joseph A Church
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, Calif; Children's Hospital Los Angeles, Los Angeles, Calif
| | - Jennifer M Puck
- Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, Calif; Institute for Human Genetics, University of California San Francisco, San Francisco, Calif; Smith Cardiovascular Research Institute, University of California San Francisco, San Francisco, Calif; Benioff Children's Hospital, University of California San Francisco, San Francisco, Calif.
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Amatuni GS, Currier RJ, Church JA, Bishop T, Grimbacher E, Nguyen AAC, Agarwal-Hashmi R, Aznar CP, Butte MJ, Cowan MJ, Dorsey MJ, Dvorak CC, Kapoor N, Kohn DB, Markert ML, Moore TB, Naides SJ, Sciortino S, Feuchtbaum L, Koupaei RA, Puck JM. Newborn Screening for Severe Combined Immunodeficiency and T-cell Lymphopenia in California, 2010-2017. Pediatrics 2019; 143:peds.2018-2300. [PMID: 30683812 PMCID: PMC6361357 DOI: 10.1542/peds.2018-2300] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Newborn screening for severe combined immunodeficiency (SCID) was instituted in California in 2010. In the ensuing 6.5 years, 3 252 156 infants in the state had DNA from dried blood spots assayed for T-cell receptor excision circles (TRECs). Abnormal TREC results were followed-up with liquid blood testing for T-cell abnormalities. We report the performance of the SCID screening program and the outcomes of infants who were identified. METHODS Data that were reviewed and analyzed included demographics, nursery summaries, TREC and lymphocyte flow-cytometry values, and available follow-up, including clinical and genetic diagnoses, treatments, and outcomes. RESULTS Infants with clinically significant T-cell lymphopenia (TCL) were successfully identified at a rate of 1 in 15 300 births. Of these, 50 cases of SCID, or 1 in 65 000 births (95% confidence interval 1 in 51 000-1 in 90 000) were found. Prompt treatment led to 94% survival. Infants with non-SCID TCL were also identified, diagnosed and managed, including 4 with complete DiGeorge syndrome who received thymus transplants. Although no cases of typical SCID are known to have been missed, 2 infants with delayed-onset leaky SCID had normal neonatal TREC screens but came to clinical attention at 7 and 23 months of age. CONCLUSIONS Population-based TREC testing, although unable to detect immune defects in which T cells are present at birth, is effective for identifying SCID and clinically important TCL with high sensitivity and specificity. The experience in California supports the rapid, widespread adoption of SCID newborn screening.
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Affiliation(s)
- George S. Amatuni
- Department of Pediatrics, University of California, San Francisco and Benioff Children’s Hospital, San Francisco, California;,Department of Cell Biology, Stem Cell Institute, Albert Einstein College of Medicine, Bronx, New York
| | - Robert J. Currier
- Department of Pediatrics, University of California, San Francisco and Benioff Children’s Hospital, San Francisco, California
| | - Joseph A. Church
- Department of Pediatrics, Keck School of Medicine, University of Southern California and Children’s Hospital Los Angeles, Los Angeles, California
| | - Tracey Bishop
- Genetic Disease Screening Program, California Department of Public Health, Richmond, California
| | - Elena Grimbacher
- School of Architecture and Urban Planning, University of Stuttgart, Stuttgart, Germany
| | | | - Rajni Agarwal-Hashmi
- Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, California
| | - Constantino P. Aznar
- Genetic Disease Screening Program, California Department of Public Health, Richmond, California
| | - Manish J. Butte
- Department of Pediatrics, University of California, Los Angeles and University of California, Los Angeles Mattel Children’s Hospital, Los Angeles, California
| | - Morton J. Cowan
- Department of Pediatrics, University of California, San Francisco and Benioff Children’s Hospital, San Francisco, California
| | - Morna J. Dorsey
- Department of Pediatrics, University of California, San Francisco and Benioff Children’s Hospital, San Francisco, California
| | - Christopher C. Dvorak
- Department of Pediatrics, University of California, San Francisco and Benioff Children’s Hospital, San Francisco, California
| | - Neena Kapoor
- Department of Pediatrics, Keck School of Medicine, University of Southern California and Children’s Hospital Los Angeles, Los Angeles, California
| | - Donald B. Kohn
- Department of Pediatrics, University of California, Los Angeles and University of California, Los Angeles Mattel Children’s Hospital, Los Angeles, California
| | - M. Louise Markert
- Department of Pediatrics, School of Medicine, Duke University, Durham, North Carolina; and
| | - Theodore B. Moore
- Department of Pediatrics, University of California, Los Angeles and University of California, Los Angeles Mattel Children’s Hospital, Los Angeles, California
| | - Stanley J. Naides
- Immunology Department, Quest Diagnostics Nichols Institute, San Juan Capistrano, California
| | - Stanley Sciortino
- Genetic Disease Screening Program, California Department of Public Health, Richmond, California
| | - Lisa Feuchtbaum
- Genetic Disease Screening Program, California Department of Public Health, Richmond, California
| | - Rasoul A. Koupaei
- Genetic Disease Screening Program, California Department of Public Health, Richmond, California
| | - Jennifer M. Puck
- Department of Pediatrics, University of California, San Francisco and Benioff Children’s Hospital, San Francisco, California
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