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A 6-year-old boy is being evaluated in the office due to a history of recurrent infections and failure to thrive. He has been hospitalized for pneumococcal pneumonia twice and has had 5 episodes of otitis media. The patient also has a history of prolonged diarrhea caused by Giardia intestinalis. Physical examination shows a lack of tonsillar tissue, as well as minimally palpable cervical, axillary, and inguinal lymph nodes. Further evaluation shows that the patient has defective signaling between activated CD4 T cells and B cells. Which of the following laboratory findings are most likely to be found in this patient?
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