TREC Screening for WHIM Syndrome

Purpose T cell receptor excision circle (TREC) quantification is a recent addition to newborn screening (NBS) programs and is intended to identify infants with severe combined immunodeficiencies (SCID). However, other primary immunodeficiency diseases (PID) have also been identified as the result of TREC screening. We recently reported a newborn with a low TREC level on day 1 of life who was diagnosed with WHIM (warts, hypogammaglobulinemia, infections, myelokathexis) syndrome, a non-SCID primary immunodeficiency caused by mutations in the chemokine receptor CXCR4. Methods We have now retrospectively reviewed the birth and clinical histories of all known WHIM infants born after the implementation of NBS for SCID. Results We identified six infants with confirmed WHIM syndrome who also had TREC quantification on NBS. Three of the six WHIM infants had low TREC levels on NBS. All six patients were lymphopenic but only one infant had a T cell count below 1,500 cells/mu L. The most common clinical manifestation was viral bronchiolitis requiring hospitalization. One infant died of complications related to Tetralogy of Fallot, a known WHIM phenotype. Conclusion The results suggest that WHIM syndrome should be considered in the differential diagnosis of newborns with low NBS TREC levels.

Automated summary

T cell receptor excision circle (TREC) quantification is a part of newborn screening programs to identify immunodeficiency diseases. Three out of six infants with WHIM syndrome had low TREC levels on screening, suggesting that WHIM syndrome should be considered in the differential diagnosis of newborns with low TREC levels.