CD40LG and Autoimmunity: Although the total B cell count in this pediatric patient was within the normal range, the increased proportions of transitional B cells and plasmablasts exceeded physiological thresholds, suggesting dysregulated negative selection and a predisposition to autoimmunity (33). A reduction in marginal zone B (MZ B) cells was also observed, potentially associated with splenectomy, which may impair IgM synthesis (34, 35).