PMC270635_01
Time course of selected laboratory data. (a) Time course of the serum protein (solid line, filled circles; left scale) and the serum albumin level (dotted lines, white circles; right scale), and (b) of the complement fragment C3d level (solid line, filled circles; left scale) and the C-reactive protein (CRP) level (dotted lines, white circles; right scale) before, during and after the onset of protein-losing enteropathy (PLE). The vertical hatched line shows the time range of PLE onset. Data are plotted versus time before/after the Fontan procedure.
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F1
Six months later the patient's serum protein and albumin levels were within normal limits (Fig. 1a). She subsequently developed oedema, and low serum protein (Fig. 1a) and gamma-globulin concentrations. The protein level was very low, and the C-reactive protein concentration (normal value < 1 mg/l) (Fig. 1b) and the neutrophil count (normal range, see Table 1) were increased. Serum albumin (Fig. 1a), gamma-globulin and IgG concentration (Fig. 2b) was decreased. Finally, complement activation (Fig. 1b), and CD45 (Fig. 2a), CD11a (LFA-1; data not shown) and CD11b (Mac-1; data not shown) expression on neutrophils were elevated. The serum albumin level normalised while the protein level was still at the lower end of the normal range and below pre-PLE levels (Fig. 1a). The serum protein, albumin, IgG and gamma-globulin levels remained below pre-PLE levels while the neutrophil count, CD45 expression on neutrophils, complement activation and anti-EBV-IgG remained increased (Figs 1 and 2).
Time course of selected immunological data. (a) Time course of the blood neutrophil count (solid black line, filled circles; left scale) and the CD45 expression on neutrophils (determined by flow cytometry and expressed as mean fluorescence intensity; dotted lines, white circles; right scale), and (b) the IgG level (solid black line, black circles; left scale) and the anti-Epstein-Barr virus (EBV)-IgG level (dotted lines, white circles; right scale) before, during and after the onset of protein-losing enteropathy (PLE). For further details, see the last two sentences of the legend to Fig. 1.
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F2
Although the serum anti-EBV IgG level (Fig. 2b) was increased twofold to threefold, the IgA and IgM concentration was normal. The serum protein, albumin, IgG and gamma-globulin levels remained below pre-PLE levels while the neutrophil count, CD45 expression on neutrophils, complement activation and anti-EBV-IgG remained increased (Figs 1 and 2).