Managing costs in primary immunodeficiency: minimal immunophenotyping and three national references.

Autor: Dias ALA; Pediatric Allergy and Immunology/Center of Investigation in Pediatrics (CIPED), Faculty of Medical Sciences, State University of Campinas - Unicamp, Sao Paulo, Brazil., da Silva RG; Laboratory of Cell Markers - Hematology/Hemotherapy Center, Faculty of Medical Sciences, State University of Campinas - Unicamp, Sao Paulo, Brazil., Cunha FGP; Laboratory of Cell Markers - Hematology/Hemotherapy Center, Faculty of Medical Sciences, State University of Campinas - Unicamp, Sao Paulo, Brazil., Morcillo AM; Pediatric Department, Faculty of Medical Sciences, State University of Campinas - Unicamp, Sao Paulo, Brazil., Lorand-Metze I; Laboratory of Cell Markers - Hematology/Hemotherapy Center, Faculty of Medical Sciences, State University of Campinas - Unicamp, Sao Paulo, Brazil., Vilela MMDS; Pediatric Allergy and Immunology/Center of Investigation in Pediatrics (CIPED), Faculty of Medical Sciences, State University of Campinas - Unicamp, Sao Paulo, Brazil., Riccetto AGL; Pediatric Allergy and Immunology/Center of Investigation in Pediatrics (CIPED), Faculty of Medical Sciences, State University of Campinas - Unicamp, Sao Paulo, Brazil.
Jazyk: angličtina
Zdroj: APMIS : acta pathologica, microbiologica, et immunologica Scandinavica [APMIS] 2019 Apr; Vol. 127 (4), pp. 228-235.
DOI: 10.1111/apm.12932
Abstrakt: Our aim was to evaluate the cost-effectiveness of a minimal lymphocyte subset quantification (LSQ) by flow cytometry as the first screening in children with clinically suspected primary immunodeficiency (PID). Two hundred sixty-eight Brazilian patients (0-21 years old) were studied. They were divided by clinical and phenotypical features into those fulfilling criteria for PID (PID phenotype) according to the 2017 International Union of Immunological Societies (IUIS) classification and those not fulfilling these criteria (non-PID phenotype). We evaluated how many patients had values below the 10th percentile for five lymphocyte subsets in peripheral blood, (suggestive of PID) according to reference values for Brazil, Italy and USA. Three lymphocyte subsets (T CD3/CD4, B CD19 and NK CD16/CD56) had p-value < 0.05 and Odds Ratio (OR) indicating a risk at least two times higher for the diagnosis of a PID phenotype. The application of Kappa coefficient (k) on Brazilian vs Italian and Brazilian vs US data sets resulted in k compatible with strong or excellent level of agreement between the three classification systems. The authors conclude that a number of CD3 + /CD4 + , CD19 + and CD16 + /CD56 + (NK) cells in peripheral blood <10th percentile represented a significant risk for the diagnosis of PID in this cohort. Natural killer (NK) deficiency is quite rare and has a very specific clinical profile. So, the analysis of these cells could be requested only in some cases, saving even more costs. The minimal immunophenotyping, with quantification of T CD4 + , CD19 + and in some cases CD16 + /CD56 + cells, may be a useful tool for the first screening of PID, saving costs, especially in developing countries.
(© 2019 APMIS. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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