Severe combined immunodeficiency

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Background

Epidemiology

  • Most common form of severe primary immunodeficiency

Pathophysiology

  • No or almost no T-cells, and any that exist do not work properly
  • Many genetic abnormalities can lead to this condition, and may cause related defects in B and NK cell lines
  • However, given that T-cells are required for B-cell function, all SCID patients are functionally B-cell deficient

Definition

  • T-cell count <300 cells/μL and no T-cell response to mitogens (<10% compared to controls)
  • Hypomorphic SCID is less severe, with a normal number of T-cells, but with T-cell function <30% compare to controls

Clinical Presentation

Diagnosis

  • Usually diagnosed at birth with newborn screen containing a TREC (T-cell receptor excision circles) assay

Prognosis

  • Uniformly fatal in childhood unless treated