Diagnosis of X linked Agammaglobulinemia should be suspected if:

X-linked agammaglobulinemia Characterized by the failure of B-cell precursors (pro-B cells and pre-B cells) to develop into mature B cells. B cells are absent or markedly decreased in the circulation,and the serum levels of all classes of immunoglobulins are depressed. Pre-B cells, which express the B-lineage marker CD19 but not membrane Ig, are found in normal numbers in the bone marrow. Germinal centers of lymph nodes, Peyer's patches, the appendix, and tonsils are underdeveloped. Plasma cells are absent throughout the body. T cell-mediated reactions are normal.