eMedicine Specialties > Allergy and Immunology > Immunodeficiencies
Severe Combined Immunodeficiency: Follow-up
Updated: May 5, 2009
Follow-up
Further Outpatient Care
- Admit the patient to an immunology/hematology clinic for intravenous immunoglobulin (IVIG) therapy, IL-2 infusion, or polyethylene glycol–conjugated adenosine deaminase replacement (PEG-ADA) therapy, as necessary.
- Frequently monitor the patient for acquired infections.
Deterrence/Prevention
- Genetic counseling is necessary. If the family wishes to have other children, suggest that they obtain prenatal testing (eg, chorionic villus sampling) if the genetic defect is known.
- Screening tests do not prevent severe combined immunodeficiency (SCID) but can identify infants early prior to complications and can allow early treatment.
- Some states now screen all neonates for the most common forms of SCID by identifying T-cell receptor excision circles (TRECs).
- TRECs are a normal byproduct of T-cell receptor rearrangement.
- In healthy neonates, TRECs are made in large numbers. In infants with SCID, they are barely detectable, making this a reasonable screening test for SCID.
- This allows identification and bone marrow transplant (BMT) before the infants become ill and greatly increases their chance of survival.19
- Microarray technology has also been proposed as a screening tool to detect the most common genetic defects leading to SCID.20
Complications
- Graft versus host disease (GVHD) may ensue if the blood products given prior to a bone marrow transplant (BMT) are not depleted of white blood cells by filtration or irradiation. Ensure that all blood products are also negative for cytomegalovirus to avoid systemic cytomegalovirus disease.
- Ensure that the child does not receive any live virus vaccines until after BMT engraftment, especially polio or bacille Calmette-Guérin (BCG). Vaccinating children with SCID is not only futile, because they cannot make antibody, but is also dangerous, because they can develop disease from attenuated viruses and may even die after exposure to these vaccines.
Prognosis
- Without treatment, death is expected to occur within 2 years. Following a successful bone marrow or other transplant, the patient may survive to adulthood.
Patient Education
- Parents of children with any immune deficiency can obtain information from the Immune Deficiency Foundation.
- Parents must not ignore a fever, rashes, or malaise in an affected child. These may indicate a serious infection.
- Instruct parents to ensure that the child does not receive live virus vaccines, especially polio or BCG. Vaccinating children with SCID prior to treatment is not only futile, because they cannot make antibody, but is also very dangerous. The live attenuated virus can be deadly and can lead to disease in these immunocompromised hosts.
- For excellent patient education resources, visit eMedicine's Yeast and Fungal Infections Center. Also, see eMedicine's patient education article Candidiasis (Yeast Infection).
Miscellaneous
Medicolegal Pitfalls
- Failure to make the diagnosis because the child is not frankly lymphopenic may present a problem, particularly in patients with Omenn syndrome, bare lymphocyte syndrome, and interleukin (IL)-2 deficiency. Obtaining lymphocyte markers and test results of antibody and lymphocyte proliferation can help physicians to avoid this pitfall.
- Ensure that the child does not receive any live virus vaccines, especially polio or bacille Calmette-Gu é rin (BCG). Vaccinating children with severe combined immunodeficiency (SCID) is futile and may be very dangerous because these children can develop disease from attenuated viruses, and they may even die after exposure to these vaccines.
More on Severe Combined Immunodeficiency |
| Overview: Severe Combined Immunodeficiency |
| Differential Diagnoses & Workup: Severe Combined Immunodeficiency |
| Treatment & Medication: Severe Combined Immunodeficiency |
Follow-up: Severe Combined Immunodeficiency |
| References |
| « Previous Page |
References
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Ege M, Ma Y, Manfras B, Kalwak K, Lu H, Lieber MR. Omenn syndrome due to ARTEMIS mutations. Blood. Jun 1 2005;105(11):4179-86. [Medline].
Hitzig WH, Landolt R, Müller G, Bodmer P. Heterogeneity of phenotypic expression in a family with Swiss-type agammaglobulinemia: observations on the acquisition of agammaglobulinemia. J Pediatr. Jun 1971;78(6):968-80. [Medline].
Chan K, Puck JM. Development of population-based newborn screening for severe combined immunodeficiency. J Allergy Clin Immunol. Feb 2005;115(2):391-8. [Medline].
Lebet T, Chiles R, Hsu AP, Mansfield ES, Warrington JA, Puck JM. Mutations causing severe combined immunodeficiency: detection with a custom resequencing microarray. Genet Med. Aug 2008;10(8):575-85. [Medline].
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Further Reading
Keywords
SCID, severe combined immunodeficiency, T-cell dysfunction, T cell dysfunction, B-cell dysfunction, B cell dysfunction, graft versus host disease, GVHD, graft-versus-host disease, graft-vs-host disease, severe infection, Swiss-type agammaglobulinemia, Janus-associated kinase 3 deficiency, JAK3 deficiency, adenosine deaminase deficiency, ADA deficiency, purine nucleoside phosphorylase deficiency, PNP deficiency, bare lymphocyte syndrome, interleukin-2 deficiency, IL-2 deficiency, ZAP-70 protein tyrosine kinase deficiency, PTK deficiency, reticular dysgenesis, Omenn syndrome, Pneumocystis carinii/jiroveci pneumonia, PCP, systemic candidiasis, generalized herpetic infections, ARTEMIS, Artemis, RAG1 deficiency, RAG2 deficiency
Follow-up: Severe Combined Immunodeficiency