Abstract
A case of Evans' syndrome with IgM deficiency and lymphopenia was studied before and after splenectomy. The lymphopenia was as a result of profound reduction of CD4 and CD8 cells. Study of cytokine secretion before splenectomy revealed a spontaneous Th1- and Th2-type cytokine production, and complete suppression of transforming growth factor (TGF)-beta. After splenectomy, the patient achieved clinical remission, the natural killer (NK) cell number increased and the pattern of cytokine production showed normalization of interleukin (IL)-2, IL-4, IL-10, TGF-beta and abolition of interferon (IFN)-gamma production. We conclude that splenectomy had a beneficial effect owing to an increase in NK cells and an associated increase in TGF-beta production.
MeSH terms
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Anemia, Hemolytic, Autoimmune / immunology*
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Anemia, Hemolytic, Autoimmune / surgery
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CD4-Positive T-Lymphocytes / immunology
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CD8-Positive T-Lymphocytes / immunology
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Child
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Cytokines / analysis*
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Humans
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Immunoglobulin M / deficiency*
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Interferon-gamma / analysis
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Interleukin-10 / analysis
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Interleukin-2 / analysis
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Interleukin-4 / analysis
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Killer Cells, Natural / immunology
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Lymphocyte Count
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Lymphopenia / immunology*
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Lymphopenia / surgery
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Male
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Purpura, Thrombocytopenic, Idiopathic / immunology*
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Purpura, Thrombocytopenic, Idiopathic / surgery
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Splenectomy
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Syndrome
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Th1 Cells / immunology*
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Th2 Cells / immunology*
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Transforming Growth Factor beta / analysis
Substances
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Cytokines
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Immunoglobulin M
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Interleukin-2
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Transforming Growth Factor beta
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Interleukin-10
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Interleukin-4
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Interferon-gamma