A Study On Glycophorin A Mutations In Children With Infectious Mononucleosis

Objective:To evaluate dynamic changes of atypical lymphocytes of peripheral blood smear in children with infectious mononucleosis(IM) and explore the relationship between the percentage variation of the atypical lymphocytes and clinical manifestations; To study the variant frequencies of glycophorin A(GPA) mutations in children with IM and hematologic disease and relationships between glycophorin A mutations and susceptibility of Epstein-Barr virus(EBV) or hematologic diseases, the relationship between GPA mutations and severity of organ damages as well as abnormality of laboratory findings.Methods:Ninety children in Shenzhen People's Hospital with IM were included from may 2008 to march 2011, among them 52 male,38 female. Children varied in age from 10 months to 11 years and 2 months. We collected the history, physical examinations,cell morphology of peripheral blood and virology of the children. The percentages of the atypical lymphocyte in peripheral blood smear were checked every 3 to 5 days in those patient children until the percentage of atypical lymphocyte dropped to lower than 3%. Among the 90 children with IM,40 children were MN heterozygote. Red blood cells were separated in pheripheral blood and GPA variant frequencies(Vf) were analysed by the combination of immunolabeling and flow cytometry in the 40 children with MN heterozygote,20 children with hematologic diseases such as acute lymphoblastic leukema, aplastic anemia, myelodysplastic syndrome and hemophagocytic syndrome and 60 children with non-hematologic diseases and non-infectious mononucleosis as controls. SPSS13.0 was used as statistics.Results:It was indicated that atypical lymphocytes appeared early in third day of the IM, increased gradually during the first week of the disease, reached highest ratio during 8-12th days then decreased slowly to normal, abnormal atypical lymphocyte count might last even till 51th days from the onset of IM.The minimum percentage of atypical lymphocyte was 11%, the maximum was 63%. There was a correlation between items of main clinical manifestations including fever, isthmitis, lymphadenectasis, hepatomegaly, splenomegaly, rash, rhinobyon, puffiness of the eyes and percentage of atypical lymphocyte. (Spearman rank correlation coefficient was 0.459, P<0.05). There were correlations between the percentage of atypical lymphocyte and the sizes of liver (r=0.411, P<0.05)as well as the percentage of atypical lymphocyte and the severity of liver damage (r=0.444, P<0.05), no significant correlation between the percentage of atypical lymphocyte and the duration of fever, size of lymph nodes, size of spleen and age of onset (P>0.05).GPA variant frequency of the groups with IM and hematologic diseases were significantly higher than that of the control(P<0.05).there was a correlation between the linear trend of GPA variant frequency and susceptibility of EBV infection or hematologic diseases (P<0.05).Conclusion:The higher the percentage of the atypical lymphocyte, the more typical the clinical manifestations, the more severe liver damage for in children with IM. The percentage of atypical lymphocyte in peripheral blood may used as a indicator to predict liver damage. The incidences of GPA mutations in the children with IM of EVB infection and in the children with hematologic diseases were higher than that of the controls, the higher GPA mutation variant frequency, the more severe liver damage, the more atypical lymphocyte for IM children, GPA mutation variant frequency may be used as a indicator to predict susceptibility of EBV infection and hematologic diseases.