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Fioredda F, Skokowa J, Tamary H, Spanoudakis M, Farruggia P, Almeida A, Guardo D, Höglund P, Newburger PE, Palmblad J, Touw IP, Zeidler C, Warren AJ, Dale DC, Welte K, Dufour C, Papadaki HA. The European Guidelines on Diagnosis and Management of Neutropenia in Adults and Children: A Consensus Between the European Hematology Association and the EuNet-INNOCHRON COST Action. Hemasphere 2023; 7:e872. [PMID: 37008163 PMCID: PMC10065839 DOI: 10.1097/hs9.0000000000000872] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/09/2023] [Indexed: 04/03/2023] Open
Abstract
Neutropenia, as an isolated blood cell deficiency, is a feature of a wide spectrum of acquired or congenital, benign or premalignant disorders with a predisposition to develop myelodysplastic neoplasms/acute myeloid leukemia that may arise at any age. In recent years, advances in diagnostic methodologies, particularly in the field of genomics, have revealed novel genes and mechanisms responsible for etiology and disease evolution and opened new perspectives for tailored treatment. Despite the research and diagnostic advances in the field, real world evidence, arising from international neutropenia patient registries and scientific networks, has shown that the diagnosis and management of neutropenic patients is mostly based on the physicians' experience and local practices. Therefore, experts participating in the European Network for the Innovative Diagnosis and Treatment of Chronic Neutropenias have collaborated under the auspices of the European Hematology Association to produce recommendations for the diagnosis and management of patients across the whole spectrum of chronic neutropenias. In the present article, we describe evidence- and consensus-based guidelines for the definition and classification, diagnosis, and follow-up of patients with chronic neutropenias including special entities such as pregnancy and the neonatal period. We particularly emphasize the importance of combining the clinical findings with classical and novel laboratory testing, and advanced germline and/or somatic mutational analyses, for the characterization, risk stratification, and monitoring of the entire spectrum of neutropenia patients. We believe that the wide clinical use of these practical recommendations will be particularly beneficial for patients, families, and treating physicians.
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Affiliation(s)
| | - Julia Skokowa
- Department of Oncology, Hematology, Immunology, Rheumatology, and Clinical Immunology, University Hospital Tübingen, Germany
| | - Hannah Tamary
- The Rina Zaizov Hematology/Oncology Division, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Israel
| | - Michail Spanoudakis
- Department of Hematology, Warrington and Halton Teaching Hospitals NHS foundation Trust, Warrington, United Kingdom
| | - Piero Farruggia
- Pediatric Onco-Hematology, ARNAS Civico Di Cristina Benfratelli Hospital, Palermo, Italy
| | - Antonio Almeida
- Department of Hematology, Hospital da Luz Lisboa, Portugal
- Faculdade de Medicina, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Daniela Guardo
- Unit of Hematology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Petter Höglund
- Clinical Immunology and Transfusion Medicine Clinic, Karolinska University Hospital, Stockholm, Sweden
- Center for Hematology and Regenerative Medicine (HERM), Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Jan Palmblad
- Center for Hematology and Regenerative Medicine (HERM), Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Ivo P. Touw
- Department of Hematology and Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Cornelia Zeidler
- Department of Oncology, Hematology, Immunology and Bone Marrow Transplantation, Hannover Medical School, Hannover, Germany
| | - Alan J. Warren
- Department of Hematology, University of Cambridge, United Kingdom
- Cambridge Institute for Medical Research, University of Cambridge, United Kingdom
- Wellcome Trust–Medical Research Council Stem Cell Institute, University of Cambridge, United Kingdom
| | | | - Karl Welte
- University Children’s Hospital Tübingen, Germany
| | - Carlo Dufour
- Unit of Hematology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Helen A. Papadaki
- Hemopoiesis Research Laboratory, School of Medicine, University of Crete, Heraklion, Greece
- Department of Hematology, University Hospital of Heraklion, Crete, Greece
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李 丽, 杨 波, 高 翔, 任 漪, 苏 敏, 杨 春, 黄 迪, 王 惠. [Risk factors for neutropenia of late newborns]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:375-380. [PMID: 33840410 PMCID: PMC8050555 DOI: 10.7499/j.issn.1008-8830.2012026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/03/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To study the risk factors and treatment for neutropenia of late newborns (NLN). METHODS Related clinical data were collected from the preterm infants and critically ill neonates who were admitted to the neonatal intensive care unit from July 2019 to January 2020. A total of 46 newborns with a blood absolute neutrophil count (ANC) of < 1.5×109/L for two consecutive times at weeks 2-4 after birth were enrolled as the NLN group. A total of 92 late newborns with a blood ANC of ≥ 1.5×109/L, matched at a ratio of 1:2, were enrolled as the control group. Possible risk factors associated with NLN and the treatment process were recorded. A logistic regression analysis was performed to identify the risk factors for NLN. RESULTS Among the 46 neonates in the NLN group, 29 had a gestational age of < 32 weeks, 14 had a gestational age of 32-37 weeks, and 3 had a gestational age of > 37 weeks. There was no significant difference between the two groups in the incidence rates of gestational hypertension, premature rupture of membranes > 18 hours and intrauterine distress, 5-minute Apgar score, the duration of positive pressure ventilation, the incidence rate of early-onset sepsis, and the type of initially used antibiotics (P > 0.05). Compared with the control group, the NLN group had a higher incidence rate of late-onset sepsis and a longer duration of antibiotic use (P < 0.05). Late-onset sepsis and prolonged duration of antibiotic use were independent risk factors for NLN (P < 0.05). With the presence of late-onset sepsis, the risk of NLN was increased by 1.537 times in neonates, and the risk of NLN was increased by 76.9% for every 3-day increase in the duration of antibiotic use. The mean age at the diagnosis of NLN was (21±6) days for the 46 neonates in the NLN group. Thirteen neonates with NLN were administered with recombinant human granulocyte colony-stimulating factor (G-CSF, 10 μg/kg) once or twice. O the 13 neonates, 6 had an ANC of < 0.5×109/L and 7 had a gestational age of < 32 weeks or severe disease conditions. After treatment the ANC returned to > 1.0×109/L in the 13 neonates. No drug-related adverse reactions were found. After the diagnosis of NLN, 2 neonates developed sepsis, and the remaining 44 neonates did not develop any common purulent infections. CONCLUSIONS The risk of NLN increases with the presence of late-onset sepsis and the increase in the duration of antibiotic use. NLN is generally a benign process. G-CSF appears to be safe and effective for NLN with severe disease conditions or severe reduction in ANC.
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Affiliation(s)
- 丽 李
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 波 杨
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 翔羽 高
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 漪 任
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 敏 苏
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 春艳 杨
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 迪 黄
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 惠颖 王
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
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Beltempo M, Viel-Thériault I, Thibeault R, Julien AS, Piedboeuf B. C-reactive protein for late-onset sepsis diagnosis in very low birth weight infants. BMC Pediatr 2018; 18:16. [PMID: 29382319 PMCID: PMC5791164 DOI: 10.1186/s12887-018-1002-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/22/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Late-onset sepsis in very low birth weight (VLBW) infants is a diagnostic challenge. We aimed to evaluate the diagnostic utility of the C-Reactive protein (CRP) and the complete blood count (CBC) for late-onset sepsis in VLBW infants. METHODS In a 5-year retrospective cohort of 416 VLBW infants born at less than 1500 g, there were 590 separate late-onset sepsis evaluations. CRP and CBC were drawn at time of initial blood culture (T0), at 16-24 h (T24) and 40-48 h (T48) after. The positive cut-off values for abnormal values were the following: CRP ≥10 mg/L and CBC with at least one anomaly, including white blood cell count < 5000/mm3, immature neutrophil/total neutrophil ratio > 0.10, or platelet count < 100,000/uL. Sensitivity and specificity for predicting late-onset sepsis were calculated for each laboratory test and their combinations. Receiver operating characteristics curves were obtained for each test and for the absolute change from T0 to T24 in the laboratory value of CRP, white blood cell count and immature neutrophil/total neutrophil. RESULTS At T0, combining the CBC and the CRP had the highest sensitivity of 66% (95% confidence interval [CI], 58-73) compared to both individual tests for predicting late onset sepsis. At T24, CRP's sensitivity was 84% (95% CI, 78-89) and was statistically higher than the CBC's 59% (95% CI, 51-67). The combination of CBC at T0 and CRP at T24 offered the greatest sensitivity of 88% (95% CI, 82-92) and negative predictive value 93% (95% CI, 89-96), with fewer samples, compared to any other combination of tests. The area under the curve for the change in the white blood cell count from T0 to T24 was 0.82. CONCLUSION At initial sepsis evaluation (T0), both CBC and CRP should be performed to increase sensitivity. A highly negative predictive value is reachable with only two tests: a CBC at T0 and a CRP a T24.
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Affiliation(s)
- Marc Beltempo
- McGill University Health Centre, Montreal, QC, Canada
| | - Isabelle Viel-Thériault
- Département de pédiatrie, Centre Mère-Enfant Soleil du CHU de Québec, Université Laval, 2705 Boulevard Laurier, QC, Québec, G1V 4G2, Canada.
| | - Roseline Thibeault
- Département de pédiatrie, Centre Mère-Enfant Soleil du CHU de Québec, Université Laval, 2705 Boulevard Laurier, QC, Québec, G1V 4G2, Canada
| | - Anne-Sophie Julien
- Centre de recherche du CHU de Québec, Université Laval, QC, Québec, Canada
| | - Bruno Piedboeuf
- Département de pédiatrie, Centre Mère-Enfant Soleil du CHU de Québec, Université Laval, 2705 Boulevard Laurier, QC, Québec, G1V 4G2, Canada.,Centre de recherche du CHU de Québec, Université Laval, QC, Québec, Canada
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Abstract
Neutropenia, usually defined as a blood neutrophil count <1·5 × 109 /l, is a common medical problem for children and adults. There are many causes for neutropenia, and at each stage in life the clinical pattern of causes and consequences differs significantly. I recommend utilizing the age of the child and clinical observations for the preliminary diagnosis and primary management. In premature infants, neutropenia is quite common and contributes to the risk of sepsis with necrotizing enterocolitis. At birth and for the first few months of life, neutropenia is often attributable to isoimmune or alloimmune mechanisms and predisposes to the risk of severe bacterial infections. Thereafter when a child is discovered to have neutropenia, often associated with relatively minor symptoms, it is usually attributed to autoimmune disorder or viral infection. The congenital neutropenia syndromes are usually recognized when there are recurrent infections, the neutropenia is severe and there are congenital anomalies suggesting a genetic disorder. This review focuses on the key clinical finding and laboratory tests for diagnosis with commentaries on treatment, particularly the use of granulocyte colony-stimulating factor to treat childhood neutropenia.
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Affiliation(s)
- David C Dale
- Department of Medicine, University of Washington, Seattle, WA, USA
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