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Matushita L, Valera ET, Aragon DC, Scridelli CA, Roxo-Junior P, de Carvalho LM. Chronic neutropenia in childhood: experience of a tertiary center. J Pediatr (Rio J) 2024; 100:311-317. [PMID: 38182128 PMCID: PMC11065660 DOI: 10.1016/j.jped.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/07/2024] Open
Abstract
OBJECTIVE To assess the prevalence of chronic neutropenia (CN) and the clinical profile of patients with CN aged up to 18 years, followed in the pediatric hematology, rheumatology, or immunology outpatient clinic of a tertiary medical center from May 1, 2018, to 30 April 2019. METHODS Retrospective observational study carried out by collecting data from the patient's medical charts. CN was defined as absolute neutrophil count (ANC) below 1.5 × 109/L lasting over three months. Autoimmune neutropenia (AIN) was defined by clinical criteria and an over twofold increase in ANC after glucocorticoid stimulation. AIN was considered secondary when associated with autoimmune or immunoregulatory disorders. Wilcoxon and Fisher's exact tests were used to compare variables; the significance level was 5 %. RESULTS A total of 1,039 patients were evaluated; 217 (20 %) presented CN. Twenty-one (2 %) had AIN, classified as primary in 57 % of the cases. The average age at the onset of symptoms was 38.6 months. During follow-up, patients had 4.2 infections on average; frequency was higher among patients with secondary AIN (p = 003). Isolated neutropenia occurred in 43 % of the patients with AIN. Neutropenia resolved in eight (38 %) of the 21 patients with AIN within 19.6 months on average. Eight patients with secondary AIN met the criteria for Inborn Errors of Immunity. CONCLUSION AIN prevalence was 2 %. Most cases were first evaluated by a pediatric immunologist or rheumatologist rather than a pediatric hematologist. This study highlights the need for a multidisciplinary approach involving a pediatric immunologist, rheumatologist, and hematologist.
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Affiliation(s)
- Letícia Matushita
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto, SP, Brazil
| | - Elvis Terci Valera
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Divisão de Oncologia e Hematologia, Ribeirão Preto, SP, Brazil
| | - Davi Casale Aragon
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Ribeirão Preto, SP, Brazil
| | - Carlos Alberto Scridelli
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Divisão de Oncologia e Hematologia, Ribeirão Preto, SP, Brazil
| | - Persio Roxo-Junior
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Divisão de Imunologia e Alergia, Ribeirão Preto, SP, Brazil
| | - Luciana Martins de Carvalho
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Pediatria, Divisão de Reumatologia Pediátrica, Ribeirão Preto, SP, Brazil.
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2
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Kurz H, Lehmberg K, Farmand S. Inborn errors of immunity with susceptibility to S. aureus infections. Front Pediatr 2024; 12:1389650. [PMID: 38720948 PMCID: PMC11078099 DOI: 10.3389/fped.2024.1389650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/25/2024] [Indexed: 05/12/2024] Open
Abstract
Staphylococcus aureus (S. aureus) is a significant human pathogen, in particular in patients with an underlying medical condition. It is equipped with a large variety of virulence factors enabling both colonization and invasive disease. The spectrum of manifestation is broad, ranging from superficial skin infections to life-threatening conditions like pneumonia and sepsis. As a major cause of healthcare-associated infections, there is a great need in understanding staphylococcal immunity and defense mechanisms. Patients with inborn errors of immunity (IEI) frequently present with pathological infection susceptibility, however, not all of them are prone to S. aureus infection. Thus, enhanced frequency or severity of S. aureus infections can serve as a clinical indicator of a specific underlying immunological impairment. In addition, the analysis of immunological functions in patients with susceptibility to S. aureus provides a unique opportunity of understanding the complex interplay between staphylococcal virulence and host immune predisposition. While the importance of quantitatively and qualitatively normal neutrophils is widely known, less awareness exists about the role of specific cytokines such as functional interleukin (IL)-6 signaling. This review categorizes well-known IEI in light of their susceptibility to S. aureus and discusses the relevant associated pathomechanisms. Understanding host-pathogen-interactions in S. aureus infections in susceptible individuals can pave the way for more effective management and preventive treatment options. Moreover, these insights might help to identify patients who should be screened for an underlying IEI. Ultimately, enhanced understanding of pathogenesis and immune responses in S. aureus infections may also be of relevance for the general population.
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Affiliation(s)
- Hannah Kurz
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kai Lehmberg
- Division of Pediatric Stem Cell Transplantation and Immunology, Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susan Farmand
- Division of Pediatric Stem Cell Transplantation and Immunology, Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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3
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Goda S, Karakawa S, Okada S, Kawaguchi H, Kurita E, Noma M, Yamaoka A, Komatsu M, Yanai A, Kashihara M, Fujii T, Onodera R, Taniguchi K, Aizawa M, Kobayashi M. Clinical significance of human neutrophil antigen-1 antibodies in children with neutropenia. Int J Hematol 2023; 118:627-635. [PMID: 37735323 DOI: 10.1007/s12185-023-03661-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023]
Abstract
Primary autoimmune neutropenia in young children is characterized by chronic neutropenia and positivity for antibodies against human neutrophil antigens (HNAs). This study analyzed the clinical characteristics of 402 children with neutropenia to identify differences between those with and without HNA-1 antibodies (HNA1abs). HNAabs in sera were detected by granulocyte immunofluorescence testing using flow cytometry. Relative fluorescence intensity (RFI) values were used to divide patients into positive (PG, n = 302), borderline (BG, n = 34), and negative (NG, n = 66) groups. The antibodies reacted to HNA-1a alone (59%), HNA-1b alone (1%), and HNA-1a/1b (40%). The PG had a significantly lower absolute neutrophil count before definitive diagnosis and a 1.6- to 2-times greater risk of hospitalization during neutropenia than the other groups. The median duration of neutropenia was longest in the PG at 25 months, followed by 20 months in the BG and 14 months in the NG. This large-scale cohort characterizes clinically distinct groups using the RFI value for HNA1abs in young children with neutropenia. Detection of HNA1abs may aid in understanding the clinical characteristics of children with neutropenia.
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Affiliation(s)
- Satoshi Goda
- Department of Pediatrics, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, Japan.
| | - Shuhei Karakawa
- Department of Pediatrics, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, Japan
| | - Satoshi Okada
- Department of Pediatrics, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, Japan
| | - Hiroshi Kawaguchi
- Department of Pediatrics, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, Japan
| | - Emi Kurita
- Division of Transfusion, Hiroshima University Hospital, Hiroshima University, Hiroshima, Japan
| | - Mitsunori Noma
- Division of Transfusion, Hiroshima University Hospital, Hiroshima University, Hiroshima, Japan
| | - Aiko Yamaoka
- Division of Transfusion, Hiroshima University Hospital, Hiroshima University, Hiroshima, Japan
| | - Mayumi Komatsu
- Division of Transfusion, Hiroshima University Hospital, Hiroshima University, Hiroshima, Japan
| | - Ayaka Yanai
- Division of Transfusion, Hiroshima University Hospital, Hiroshima University, Hiroshima, Japan
| | - Mayu Kashihara
- Division of Transfusion, Hiroshima University Hospital, Hiroshima University, Hiroshima, Japan
| | - Teruhisa Fujii
- Division of Transfusion, Hiroshima University Hospital, Hiroshima University, Hiroshima, Japan
| | - Rie Onodera
- Department of Medical Technology, Sanyo Women's College, Hatsukaichi, Japan
| | - Kikuyo Taniguchi
- Department of Medical Technology, Sanyo Women's College, Hatsukaichi, Japan
| | - Mika Aizawa
- Department of Applied Chemistry, Graduate School of Advanced Science and Engineering, Hiroshima University, Higashi-Hiroshima, Japan
| | - Masao Kobayashi
- Japanese Red Cross Chugoku-Shikoku Block Blood Center, Hiroshima, Japan
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4
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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: 9] [Impact Index Per Article: 9.0] [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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5
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Dobrewa W, Madzio J, Babol-Pokora K, Lopacz P, Gierszon A, Guz K, Orzinska A, Uhrynowska M, Jasinska A, Zdunek M, Mlynarski W, Janczar S. A high prevalence of neutrophil-specific antibodies in ELANE-mutated severe congenital neutropenia. Pediatr Blood Cancer 2023; 70:e30247. [PMID: 36734404 DOI: 10.1002/pbc.30247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/04/2023] [Accepted: 01/20/2023] [Indexed: 02/04/2023]
Abstract
An assay for neutrophil-specific antibodies is frequently used in the workup of chronic severe neutropenia and is suggestive of autoimmune, or sporadically alloimmune neutropenia, rather than severe congenital neutropenia (SCN). We analyzed a neutropenia consortium database for the outcomes of antibody testing initiated before receiving genetic diagnosis in Polish SCN cohort. Test results, performed in a single reference laboratory, were available for 14 patients with ELANE-mutated SCN or cyclic neutropenia, and were frequently positive (36%). We note that the trigger for genetic studies in severe neutropenia should not be affected by antibody-positivity and should be clinically driven.
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Affiliation(s)
- Weronika Dobrewa
- Department of Pediatrics, Oncology and Haematology, Medical University of Lodz, Lodz, Poland
| | - Joanna Madzio
- Department of Pediatrics, Oncology and Haematology, Medical University of Lodz, Lodz, Poland
| | - Katarzyna Babol-Pokora
- Department of Pediatrics, Oncology and Haematology, Medical University of Lodz, Lodz, Poland
| | - Patrycja Lopacz
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Agnieszka Gierszon
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Katarzyna Guz
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Agnieszka Orzinska
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Malgorzata Uhrynowska
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Aleksandra Jasinska
- Department of Pediatrics, Oncology and Haematology, Medical University of Lodz, Lodz, Poland
| | - Maciej Zdunek
- Department of Pediatrics, Oncology and Haematology, Medical University of Lodz, Lodz, Poland
| | - Wojciech Mlynarski
- Department of Pediatrics, Oncology and Haematology, Medical University of Lodz, Lodz, Poland
| | - Szymon Janczar
- Department of Pediatrics, Oncology and Haematology, Medical University of Lodz, Lodz, Poland
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6
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Rophina M, Bhoyar RC, Imran M, Senthivel V, Divakar MK, Mishra A, Jolly B, Sivasubbu S, Scaria V. Genetic landscape of human neutrophil antigen variants in India from population-scale genomes. HLA 2023; 101:262-269. [PMID: 36502377 DOI: 10.1111/tan.14938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/08/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
Antibodies against human neutrophil antigens (HNAs) play a significant role in various clinical conditions such as neonatal alloimmune neutropenia, transfusion-related acute lung injury, and other nonhemolytic transfusion reactions. This study aims to identify the genotype and allele frequencies of HNAs in the healthy Indian population. Ten genetic variants in four human genes encoding alleles of HNAs class I-V approved by the International Society of Blood Transfusion-Granulocyte Immunobiology Working Party were used in the analysis. Genetic variants from whole genome sequences of 1029 healthy Indian individuals corresponding to HNA alleles were analyzed. The frequencies of the variants were compared with global population datasets using an in-house computational pipeline. In HNA class I, allele frequencies of FCGR3B*01, FCGR3B*02, and FCGR3B*03 encoding HNA-1a, HNA-1b, and HNA-1c were 0.07, 0.8, and 0.13, respectively. HNA class 3 alleles namely SLC44A2*01 (encoding HNA-3a) and SLC44A2*02 (encoding HNA-3b) were found at allele frequencies of 0.78 and 0.22, respectively. The frequencies of ITGAM*01 encoding HNA-4a and ITGAM*02 encoding HNA-4a were 0.95 and 0.05, respectively. Furthermore, allele frequencies of HNA class 5 alleles were 0.32 for ITGAL*01 (encoding HNA-5a) and 0.68 for ITGAL*02 (encoding HNA-5b). Interestingly, it was also found that rs2230433 variant deciding the HNA class 5 alleles, was highly prevalent (78.2%) in the Indian population compared with other global populations. This study presents the first comprehensive report of HNA allele and genotype frequencies in the Indian population using population genome datasets of 1029 individuals. Significant difference was observed in the prevalence of HNA5a and HNA5b in India in comparison to other global populations.
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Affiliation(s)
- Mercy Rophina
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Rahul C Bhoyar
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Mohamed Imran
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Vigneshwar Senthivel
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Mohit Kumar Divakar
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Anushree Mishra
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Bani Jolly
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Sridhar Sivasubbu
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Vinod Scaria
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
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7
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Elgharbawy FM, Karim MY, Soliman DS, Hassan AS, Sudarsanan A, Gad A. Case report: Neonatal autoimmune lymphoproliferative syndrome with a novel pathogenic homozygous FAS variant effectively treated with sirolimus. Front Pediatr 2023; 11:1150179. [PMID: 37152306 PMCID: PMC10159173 DOI: 10.3389/fped.2023.1150179] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/27/2023] [Indexed: 05/09/2023] Open
Abstract
Background Autoimmune lymphoproliferative syndrome (ALPS) is a rare disease characterized by defective FAS signaling, which results in chronic, nonmalignant lymphoproliferation and autoimmunity accompanied by increased numbers of "double-negative" T-cells (DNTs) (T-cell receptor αβ+ CD4-CD8-) and an increased risk of developing malignancies later in life. Case presentation We herein report a case of a newborn boy with a novel germline homozygous variant identified in the FAS gene, exon 9, c.775del, which was considered pathogenic. The consequence of this sequence change was the creation of a premature translational stop signal p.(lle259*), associated with a severe clinical phenotype of ALPS-FAS. The elder brother of the proband was also affected by ALPS and has been found to have the same FAS homozygous variant associated with a severe clinical phenotype of ALPS-FAS, whereas the unaffected parents are heterozygous carriers of this variant. This new variant has not previously been described in population databases (gnomAD and ExAC) or in patients with FAS-related conditions. Treatment with sirolimus effectively improved the patient clinical manifestations with obvious reduction in the percentage of DNTs. Conclusion We described a new ALPS-FAS clinical phenotype-associated germline FAS homozygous pathogenic variant, exon 9, c.775del, that produces a premature translational stop signal p.(lle259*). Sirolimus significantly reduced DNTs and substantially relieved the patient's clinical symptoms.
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Affiliation(s)
- Fawzia M. Elgharbawy
- Neonatal Intensive Care Unit, Department of Pediatrics, AL Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine- Qatar (WCM-Q), Cornell University, Doha, Qatar
- Correspondence: Fawzia Elgharbawy
| | - Mohammed Yousuf Karim
- Immunopathology Section, Sidra Medicine, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
| | - Dina Sameh Soliman
- Weill Cornell Medicine- Qatar (WCM-Q), Cornell University, Doha, Qatar
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Amel Siddik Hassan
- Allergy and Immunology section, Department of Pediatrics, Sidra Medicine, Doha, Qatar
| | - Anoop Sudarsanan
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Ashraf Gad
- Weill Cornell Medicine- Qatar (WCM-Q), Cornell University, Doha, Qatar
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
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8
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Neutropenia: diagnosis and management. World J Pediatr 2022; 18:771-777. [PMID: 35962272 DOI: 10.1007/s12519-022-00593-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/05/2022] [Indexed: 10/15/2022]
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9
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Yassin MA, Soliman AT, Hmissi SM, Abdulla MA, Itani M, Alamami AA, Aldapt MB, Suliman AM, Ibrahim EA, Mohamed MF, Rozi W, Mohamed SF, Chandra P, Nashwan AJ. Prevalence of neutropenia among adult Arabs in Qatar: Relation to other hematological parameters and anthropometric data. Medicine (Baltimore) 2022; 101:e30431. [PMID: 36086749 PMCID: PMC10980397 DOI: 10.1097/md.0000000000030431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 07/27/2022] [Indexed: 11/26/2022] Open
Abstract
Neutropenia ranges from a normal variant to life-threatening acquired and congenital disorders. This study aims at providing baseline information regarding the prevalence and spectrum of neutropenia in the Arab blood donors who are living in Qatar. This retrospective cohort study was conducted to review the data of healthy Arab individuals (≥18 years) who donated blood between January 1, 2015 to May 15, 2019. A complete blood count was performed using automated analyzers. The prevalence of neutropenia was 10.7%. The prevalence in females was 32% and in males, it was 6%. Absolute neutrophil count (ANC) below 1 × 109/L was detected in 10% of Arab females and 1.8 % of Arab males. In females, the neutropenic group had significantly lower hemoglobin (Hb) levels and higher red cell distribution width, and lower total white blood cells and lymphocyte counts (P < .001) compared to the group with ANC > 1.5 × 109/L. Significant correlations were found between the ANC and Hb (r = 0.33, P < .05) and ANC and total white blood cells (r = 0.45, P < .01). The prevalence of neutropenia is considerably high in Arab adult females compared to other ethnic groups. Besides the genetic constitution of Arabs, the lower Hb and higher red cell distribution width in females suggest that iron deficiency could contribute to the development of neutropenia.
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Affiliation(s)
- Mohamed A. Yassin
- Department of Medical Oncology/Hematology, National Centre for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ashraf T. Soliman
- Division of Endocrinology, Department of Pediatrics, Hamad General Hospital (HGH), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Saloua M. Hmissi
- Blood Transfusion Center, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Mohammad A.J. Abdulla
- Department of Medical Oncology/Hematology, National Centre for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Maya Itani
- Department of Dietetics and Nutrition, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ans A. Alamami
- Department of Critical Care Medicine, Hamad General Hospital (HGH), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Mahmood B. Aldapt
- Department of Medical Oncology/Hematology, National Centre for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Aasir M. Suliman
- Department of Medical Oncology/Hematology, National Centre for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ezzeddin A. Ibrahim
- Department of Medical Oncology/Hematology, National Centre for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar
| | | | - Waail Rozi
- Department of Medical Oncology/Hematology, National Centre for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Shehab F. Mohamed
- Department of Medical Oncology/Hematology, National Centre for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Prem Chandra
- Medical Research Center, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Abdulqadir J. Nashwan
- Department of Nursing, Hazm Mebaireek General Hospital (HMGH), Hamad Medical Corporation (HMC), Doha, Qatar
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10
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Nepesov S, Yaman Y, Elli M, Bayram N, Ozdilli K, Ayaz A, Anak S. Chronic Neutropenia in Childhood: Laboratory and Clinical Features. Indian J Pediatr 2022; 89:894-898. [PMID: 35267133 DOI: 10.1007/s12098-022-04104-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/12/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To describe the clinical characteristics of patients with chronic neutropenia. METHODS Data of 36 patients with chronic neutropenia, who were followed up in the authors' clinic between May 2013 and May 2020, were analyzed retrospectively. Patients were diagnosed based on their clinical and laboratory characteristics. RESULTS A total of 36 patients (23 females, 13 males) were included in the study. The mean age at diagnosis was 9.85 ± 9.17 mo while the mean follow-up time was 21.83 ± 20.03 mo. The mean absolute neutrophil count (ANC) at admission was 462.5 ± 388.8 cells/mm3 (median = 375 cells/mm3), and the lowest and highest ANC mean was 241.2 ± 262.1 cells/mm3 (median = 125 cells/mm3), and 1362.9 ± 1127.9 cells/mm3 (median = 925 cells/mm3), respectively. Idiopathic neutropenia was found in 28 (77.8%) patients, autoimmune neutropenia in 6 (16.7%) patients, and congenital neutropenia in 2 (5.6%) patients. Neutrophil normalization was observed in 19 (52.8%) of the patients. CONCLUSIONS Chronic neutropenia is a heterogeneous picture that presents with different clinical symptoms in childhood. The cause of neutropoenia in children is usually benign and resolves spontaneously but especially in those with severe neutropoenia genetic examination should be performed.
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Affiliation(s)
- Serdar Nepesov
- Department of Pediatric Allergy and Immunology, İstanbul Medipol University, İstanbul, 34214, Turkey.
| | - Yontem Yaman
- Department of Pediatric Hematology and Oncology, İstanbul Medipol University, İstanbul, Turkey
| | - Murat Elli
- Department of Pediatric Hematology and Oncology, İstanbul Medipol University, İstanbul, Turkey
| | - Nihan Bayram
- Department of Pediatric Hematology and Oncology, İstanbul Medipol University, İstanbul, Turkey
| | - Kursat Ozdilli
- Department of Pediatric Hematology and Oncology, İstanbul Medipol University, İstanbul, Turkey
| | - Akif Ayaz
- Department of Medical Genetics, İstanbul Medipol University, İstanbul, Turkey
| | - Sema Anak
- Department of Pediatric Hematology and Oncology, İstanbul Medipol University, İstanbul, Turkey
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11
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Roganovic J, Ricci E, Polychronopoulou S, Fioredda F. Isolated neutropenia preceding acute lymphoblastic leukemia in children. Pediatr Blood Cancer 2022; 69:e29518. [PMID: 34913255 DOI: 10.1002/pbc.29518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Jelena Roganovic
- Division of Hematology, Oncology and Clinical Genetics, Department of Pediatrics, University Hospital Center Rijeka, Rijeka, Croatia
| | - Erica Ricci
- Hematology Unit, Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Istituto Giannina Gaslini, Genoa, Italy
| | - Sophia Polychronopoulou
- Department of Pediatric Hematology and Oncology, Aghia Sophia Childrens' Hospital, Athens, Greece
| | - Francesca Fioredda
- Hematology Unit, Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Istituto Giannina Gaslini, Genoa, Italy
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12
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Schiavo E, Martini B, Attardi E, Consonni F, Ciullini Mannurita S, Coniglio ML, Tellini M, Chiocca E, Fotzi I, Luti L, D'Alba I, Veltroni M, Favre C, Gambineri E. Autoimmune Cytopenias and Dysregulated Immunophenotype Act as Warning Signs of Inborn Errors of Immunity: Results From a Prospective Study. Front Immunol 2022; 12:790455. [PMID: 35058929 PMCID: PMC8765341 DOI: 10.3389/fimmu.2021.790455] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/22/2021] [Indexed: 12/19/2022] Open
Abstract
Inborn errors of immunity (IEI) are genetic disorders characterized by a wide spectrum of clinical manifestations, ranging from increased susceptibility to infections to significant immune dysregulation. Among these, primary immune regulatory disorders (PIRDs) are mainly presenting with autoimmune manifestations, and autoimmune cytopenias (AICs) can be the first clinical sign. Significantly, AICs in patients with IEI often fail to respond to first-line therapy. In pediatric patients, autoimmune cytopenias can be red flags for IEI. However, for these cases precise indicators or parameters useful to suspect and screen for a hidden congenital immune defect are lacking. Therefore, we focused on chronic/refractory AIC patients to perform an extensive clinical evaluation and multiparametric flow cytometry analysis to select patients in whom PIRD was strongly suspected as candidates for genetic analysis. Key IEI-associated alterations causative of STAT3 GOF disease, IKAROS haploinsufficiency, activated PI3Kδ syndrome (APDS), Kabuki syndrome and autoimmune lymphoproliferative syndrome (ALPS) were identified. In this scenario, a dysregulated immunophenotype acted as a potential screening tool for an early IEI diagnosis, pivotal for appropriate clinical management and for the identification of new therapeutic targets.
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Affiliation(s)
- Ebe Schiavo
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Beatrice Martini
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Enrico Attardi
- Division of Hematology, Careggi University Hospital, Florence, Italy
| | - Filippo Consonni
- Meyer University Children's Hospital, University of Florence, Florence, Italy
| | - Sara Ciullini Mannurita
- Centre of Excellence, Division of Pediatric Oncology/Hematology, Meyer University Children's Hospital, Florence, Italy
| | - Maria Luisa Coniglio
- Centre of Excellence, Division of Pediatric Oncology/Hematology, Meyer University Children's Hospital, Florence, Italy
| | - Marco Tellini
- Meyer University Children's Hospital, University of Florence, Florence, Italy
| | - Elena Chiocca
- Centre of Excellence, Division of Pediatric Oncology/Hematology, Meyer University Children's Hospital, Florence, Italy
| | - Ilaria Fotzi
- Centre of Excellence, Division of Pediatric Oncology/Hematology, Meyer University Children's Hospital, Florence, Italy
| | - Laura Luti
- Division of Pediatric Oncology/Hematology, University Hospital of Pisa, Pisa, Italy
| | - Irene D'Alba
- Division of Pediatric Oncology/Hematology, University Hospital of Ospedali Riuniti, Ancona, Italy
| | - Marinella Veltroni
- Centre of Excellence, Division of Pediatric Oncology/Hematology, Meyer University Children's Hospital, Florence, Italy
| | - Claudio Favre
- Centre of Excellence, Division of Pediatric Oncology/Hematology, Meyer University Children's Hospital, Florence, Italy
| | - Eleonora Gambineri
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy.,Centre of Excellence, Division of Pediatric Oncology/Hematology, Meyer University Children's Hospital, Florence, Italy
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13
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Consonni F, Gambineri E, Favre C. ALPS, FAS, and beyond: from inborn errors of immunity to acquired immunodeficiencies. Ann Hematol 2022; 101:469-484. [PMID: 35059842 PMCID: PMC8810460 DOI: 10.1007/s00277-022-04761-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/11/2022] [Indexed: 12/13/2022]
Abstract
Autoimmune lymphoproliferative syndrome (ALPS) is a primary immune regulatory disorder characterized by benign or malignant lymphoproliferation and autoimmunity. Classically, ALPS is due to mutations in FAS and other related genes; however, recent research revealed that other genes could be responsible for similar clinical features. Therefore, ALPS classification and diagnostic criteria have changed over time, and several ALPS-like disorders have been recently identified. Moreover, mutations in FAS often show an incomplete penetrance, and certain genotypes have been associated to a dominant or recessive inheritance pattern. FAS mutations may also be acquired or could become pathogenic when associated to variants in other genes, delineating a possible digenic type of inheritance. Intriguingly, variants in FAS and increased TCR αβ double-negative T cells (DNTs, a hallmark of ALPS) have been identified in multifactorial autoimmune diseases, while FAS itself could play a potential role in carcinogenesis. These findings suggest that alterations of FAS-mediated apoptosis could trespass the universe of inborn errors of immunity and that somatic mutations leading to ALPS could only be the tip of the iceberg of acquired immunodeficiencies.
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Affiliation(s)
- Filippo Consonni
- Anna Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Eleonora Gambineri
- Division of Pediatric Oncology/Hematology, BMT Unit, Meyer University Children's Hospital, Viale Gaetano Pieraccini 24, 50139, Florence, Italy.
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy.
| | - Claudio Favre
- Division of Pediatric Oncology/Hematology, BMT Unit, Meyer University Children's Hospital, Viale Gaetano Pieraccini 24, 50139, Florence, Italy
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14
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Connelly JA. Diagnosis and therapeutic decision-making for the neutropenic patient. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:492-503. [PMID: 34889413 PMCID: PMC8791128 DOI: 10.1182/hematology.2021000284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Determining the cause of a low neutrophil count in a pediatric or adult patient is essential for the hematologist's clinical decision-making. Fundamental to this diagnostic process is establishing the presence or lack of a mature neutrophil storage pool, as absence places the patient at higher risk for infection and the need for supportive care measures. Many diagnostic tests, eg, a peripheral blood smear and bone marrow biopsy, remain important tools, but greater understanding of the diversity of neutropenic disorders has added new emphasis on evaluating for immune disorders and genetic testing. In this article, a structure is provided to assess patients based on the mechanism of neutropenia and to prioritize testing based on patient age and hypothesized pathophysiology. Common medical quandaries including fever management, need for growth factor support, risk of malignant transformation, and curative options in congenital neutropenia are reviewed to guide medical decision-making in neutropenic patients.
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Affiliation(s)
- James A. Connelly
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
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15
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Callejas Caballero I, Illán Ramos M, Berzosa Sánchez A, Anguita E, Ramos Amador JT. Autoimmune neutropenia associated with influenza virus infection in childhood: a case report. BMC Infect Dis 2021; 21:830. [PMID: 34407762 PMCID: PMC8371585 DOI: 10.1186/s12879-021-06506-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although neutropenia is relatively frequent in infants and children and is mostly a benign condition with a self-limited course, it can lead to life-threatening severe infections. Autoimmune neutropenia is a relatively uncommon hematological disorder characterized by the autoantibody-induced destruction of neutrophils. It is usually triggered by viral infections with very few documented cases after influenza virus. CASE PRESENTATION An 8-month-old male infant presented at the emergency room with a 5-days history of fever up to 39.7 °C, cough and runny nose. In the blood test performed, severe neutropenia was diagnosed (neutrophils 109/μL). A nasopharyngeal aspirate revealed a positive rapid test for Influenza A. Serum antineutrophil antibodies were determined with positive results. Neutropenia targeted panel showed no mutations. Despite maintenance of severe neutropenia for 9 months the course was uneventful without treatment. CONCLUSIONS When severe neutropenia is diagnosed and confirmed, it is essential to rule out some potential etiologies and underlying conditions, since the appropriate subsequent management will depend on it. Although autoimmune neutropenia triggered by viral infections has been widely reported, it has seldom been reported after influenza infection. The benign course of the disease allows a conservative management in most cases.
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Affiliation(s)
| | - Marta Illán Ramos
- Department of Paediatrics, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Eduardo Anguita
- Department of Hematology, Hospital Universitario Clínico San Carlos, IML, IdISSC, Madrid, Spain.,Department of Medicine, UCM, Madrid, Spain
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16
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Autoimmune pancytopenia after liver transplantation: A case report. Transfus Apher Sci 2021; 60:103136. [PMID: 33895070 DOI: 10.1016/j.transci.2021.103136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Autoimmune hemolytic anemia (AIHA), immune thrombocytopenia (ITP), and autoimmune neutropenia (AIN) are reported in the literature after liver, intestinal, heart, pancreas, and kidney transplants. We report a case of autoimmune pancytopenia (AIHA, AIN and ITP) 9 years after liver transplantation with confirmed erythrocyte and neutrophil auto-antibodies. CASE REPORT A 49 years old man was admitted to our hospital presented with dysentery and fever, with history of liver transplantation in 2008. Laboratory evaluation demonstrated hemoglobin: 7.2 g/dL, granulocytes: 0.10 × 109/L and platelets: 15 × 109/mm³; indirect bilirubin: 3.62 mg/dL; lactate dehydrogenase: 603 U/L. Direct antiglobulin test revealed a monospecific anti-IgG plus C3 and the acid eluate was reactive to all panel red cells, consistent with an AIHA. Granulocyte immunofluorescence test (GIFT) and agglutination test (GAT) were reactive for granulocytes. Test with Luminex technology for human neutrophil antigen (HNA) antibody detection was strong reactive with beads expressing HNA-1a, -1b, -1c, -2, -4a and -5a antigens. HNA genotyping revealed the presence of the corresponding antigens, confirming the autoantibodies. Test with Luminex technology for human leucocyte antigen (HLA) antibody detection was negative. Monoclonal antibody immobilization of platelet antigens (MAIPA) assay was negative. Viral causes were excluded. The condition was compatible with clinical onset of autoimmune pancytopenia. Prednisone was administered at an initial dose of 1 mg/kg/day and immunosuppressive therapy was adjusted. This treatment resulted in rapid resolution of pancytopenia. CONCLUSION Combined autoimmune pancytopenia (AIHA, AIN and ITP) is a rare condition that may occur after liver transplantation. Early recognition of this phenomenon permits appropriate treatment.
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17
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Kang EM. Disease Presentation, Treatment Options, and Outcomes for Myeloid Immunodeficiencies. Curr Allergy Asthma Rep 2021; 21:14. [PMID: 33666780 DOI: 10.1007/s11882-020-00984-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW Up-to-date review on various types of immunodeficiencies with a significant myeloid component including some more recently described congenital disorders. RECENT FINDINGS While a number of disorders have been described in the past, genetic sequencing has led to the identification of the specific disorders and clarified their pathophysiology. Advances in genetic therapies including genetic editing should provide future treatments beyond hematopoietic stem cell transplant for patients with these rare disorders. Neutrophils (or granulocytes) are a major contributor to infection surveillance and clearance, and defective neutrophils characteristically lead to pyogenic infections. Deficiency in numbers, either iatrogenic or congenital; functional defects; and/or inability to target to the sites of infection can all lead to serious morbidity and mortality; however, myeloid-based immunodeficiencies are not all the same. Having absent neutrophils, that is, neutropenia, has implications different to those of having dysfunctional neutrophils as will become evident as the various disorders are reviewed.
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Affiliation(s)
- Elizabeth M Kang
- National Institutes of Allergy and Infectious Disease/National Institutes of Health, 10 Center Drive, Room 6-3752, Bethesda, MD, 20892, USA.
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18
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Jinca C, Serban M, Ursu E, Munteanu A, Arghirescu S. Primary autoimmune neutropenia of infancy and childhood in a cohort of patients from western Romania. Exp Ther Med 2021; 21:280. [PMID: 33603887 DOI: 10.3892/etm.2021.9711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/19/2020] [Indexed: 12/25/2022] Open
Abstract
Neutropenia is commonly diagnosed in pediatric clinics. Due to the special vulnerability of neutropenic patients, the assessment of the etiopathogenic background of neutropenia is mandatory. In this retrospective cross-sectional cohort study, we aimed to establish the status of primary autoimmune neutropenia (AIN) from the point of view of its clinical and biological features and its outcome in a cohort of pediatric patients. We recorded all of the 3,488 cases consecutively admitted to our hospital for different diagnoses but presenting neutropenia, during a period of 3 years (January 2016 to December 2018). We had to exclude 224 patients from the analysis due to incomplete data. Our study focused on patients with AIN or chronic benign neutropenia of infancy and childhood. In these patients, a granulocyte antibody screening by granulocyte immunofluorescence test (GIFT) and the granulocyte agglutination test (GAT) were performed. Regarding their pathogenic background, 0.1% of the patients presenting neutropenia were congenital forms, the rest being acquired forms. Primary AIN was encountered in 18 cases, representing approximately 0.5%. The median age at onset for primary AIN was 7.5 months. Male/female ratio in AIN was 1.94. In 72% of the patients with AIN, neutropenia was severe during the course of disease. In 3 patients, both GIFT and GAT were positive and in 8 patients, only GIFT was positive. For the remaining 7 patients (39%), both GIFT and GAT revealed negative results. 50% of the patients needed hospitalization, but only 3 patients presented severe infections. On-demand G-CSF was administered in 22% of the patients. Our study provides insight with regard to neutropenia, showing the high frequency and etiological diversity in childhood. Primary AIN is usually diagnosed by exclusion of the other causes of neutropenia. GIFT and GAT are useful, but rarely available diagnostic tools for the confirmation of primary AIN.
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Affiliation(s)
- Cristian Jinca
- Department of Pediatrics, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Margit Serban
- Department of Onco-Hematology, 'Louis Turcanu' Emergency Hospital for Children, 300011 Timisoara, Romania
| | - Emilia Ursu
- Department of Onco-Hematology, 'Louis Turcanu' Emergency Hospital for Children, 300011 Timisoara, Romania
| | - Andrei Munteanu
- Department of Puericulture and Neonatology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Smaranda Arghirescu
- Department of Pediatrics, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
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19
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Goda S, Hayakawa S, Karakawa S, Okada S, Kawaguchi H, Kobayashi M. Possible involvement of regulatory T cell abnormalities and variational usage of TCR repertoire in children with autoimmune neutropenia. Clin Exp Immunol 2020; 204:1-13. [PMID: 33289074 DOI: 10.1111/cei.13559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 01/16/2023] Open
Abstract
Autoimmune neutropenia (AIN) in childhood is characterized by chronic neutropenia and positivity for anti-neutrophil antibodies, resulting in the excessive destruction of neutrophils. In this study, we investigated the involvement of regulatory T cells (Tregs ) in the pathogenesis of AIN in childhood. Tregs have been classified into three subpopulations based on the expressions of CD45RA and forkhead box protein 3 (FoxP3): resting Tregs , activated Tregs and non-suppressive Tregs . The frequency of activated Tregs (CD4+ CD25+ FoxP3high CD45RA- T cells) as well as that of total Tregs (CD4+ CD25+ FoxP3+ T cells) in peripheral blood was significantly decreased in patients with AIN. Analysis of the T cell receptor (TCR)-Vβ repertoire of CD4+ T cells revealed skewed usages in patients with AIN compared with that observed in age-matched control subjects. Regarding T cell subsets, the use of four of 24 TCR-Vβ families in Tregs and one in conventional T cells were increased in patients with AIN. The number of patients with AIN who showed skewed usages of TCR-Vβ family in conventional and Tregs was significantly higher than that reported in control subjects. When the preference between Tregs and conventional T cells in each TCR-Vβ family was individually compared, different use was prominently observed in the TCR-Vβ 9 family in patients with AIN. These results suggest that the quantitative abnormalities of Tregs and the skew of the TCR-Vβ repertoire in CD4+ T cells, including Tregs and conventional T cells, may be related to autoantibody production through a human neutrophil antigen-reactive T cell clone.
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Affiliation(s)
- S Goda
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - S Hayakawa
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - S Karakawa
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - S Okada
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - H Kawaguchi
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - M Kobayashi
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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20
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Nagalapuram V, McCall D, Palabindela P, Howard TH, Bemrich-Stolz C, Lebensburger J, Hilliard L, Wilson HP. Outcomes of Isolated Neutropenia Referred to Pediatric Hematology-Oncology Clinic. Pediatrics 2020; 146:peds.2019-3637. [PMID: 32883808 DOI: 10.1542/peds.2019-3637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Children with isolated neutropenia (absolute neutrophil count [ANC] <1500/μL) are frequently referred to pediatric hematology and oncology clinics for further diagnostic evaluation. Scant literature exists on interventions and outcomes for isolated neutropenia. We hypothesized that children will have resolution of their neutropenia without the need for intervention(s) by a pediatric hematologist and oncologist. METHODS We performed a 5.5-year institutional review board-approved retrospective chart review of children referred to our pediatric hematology and oncology clinics for isolated neutropenia. Neutropenia was categorized as mild (ANC of 1001-1500/μL), moderate (ANC of 500-1000 μL), severe (ANC of 201-500/μL), or very severe (ANC of ≤200/μL). RESULTS Among 155 children referred with isolated neutropenia, 45 (29%) had mild neutropenia, 65 (42%) had moderate neutropenia, 30 (19%) had severe neutropenia, and 15 (10%) had very severe neutropenia. Only 29 (19%) children changed to an ANC category lower than their initial referral category. At a median follow-up of 12 months, 101 children had resolution of neutropenia, 40 children had mild neutropenia, 10 children had moderate neutropenia, 3 children had severe neutropenia, and 1 patient had very severe neutropenia. A specific diagnosis was not identified in most (54%) children. The most common etiologies were viral suppression (16%), autoimmune neutropenia (14%), and drug-induced neutropenia (8%). Black children had a 3.5 higher odds of having persistent mild neutropenia. Six (4%) children received granulocyte colony-stimulating factor therapy. CONCLUSIONS Most children referred for isolated neutropenia do not progress in severity and do not require subspecialty interventions or hospitalizations.
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Affiliation(s)
- Vishnu Nagalapuram
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama; and
| | - David McCall
- MD Anderson Cancer Center, The University of Texas, Houston, Texas
| | - Prasannalaxmi Palabindela
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Thomas H Howard
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Christina Bemrich-Stolz
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Jeffrey Lebensburger
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Lee Hilliard
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Hope P Wilson
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama; and
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21
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Browne T, Dearman RJ, Poles A. Human neutrophil antigens: Nature, clinical significance and detection. Int J Immunogenet 2020; 48:145-156. [PMID: 32970372 DOI: 10.1111/iji.12514] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/11/2020] [Accepted: 08/27/2020] [Indexed: 12/18/2022]
Abstract
Granulocytes are an essential part of both the innate and adaptive immune systems. Human neutrophil antigens (HNAs) are a family of epitopes that are located on glycoproteins that are mostly expressed on human granulocytes. Antibodies that recognize these epitopes have been associated with neutropenia, transfusion complications, haematopoietic stem cell transplant nonengraftment and renal transplant rejection. Currently, there are fourteen recognized HNA alleles across five antigen systems (HNA-1 through HNA-5), the molecular basis of which are located on the genes FCGR3B, CD177, SLC44A2, ITGAM and ITGAL, respectively. Elucidation of the associated genes has permitted the development of testing strategies for HNA typing and aided understanding of the associated epitopes. This review will outline the associated clinical conditions that require HNA investigation and how these are performed in specialized laboratories. Investigations provided are both reactive for patients with a variety of existing or suspected neutropenias and proactive in the testing of blood component donors in order to reduce the potential risk to patients who require transfusion.
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Affiliation(s)
- Tom Browne
- Histocompatibility and Immunogenetics Laboratory, NHS Blood and Transplant, Filton, Bristol, UK
| | - Rebecca J Dearman
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Anthony Poles
- Histocompatibility and Immunogenetics Laboratory, NHS Blood and Transplant, Filton, Bristol, UK
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22
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Kirk SE, Grimes AB, Shelke S, Despotovic JM, Powers JM. The cost of a "benign" condition: Healthcare utilization and infectious outcomes in young children with primary autoimmune neutropenia. Pediatr Blood Cancer 2020; 67:e28146. [PMID: 31886613 DOI: 10.1002/pbc.28146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/05/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Autoimmune neutropenia (AIN) is a common cause of chronic neutropenia in childhood. Despite an expected benign clinical course, many patients undergo extensive evaluation. Data on healthcare utilization and rates of bloodstream infections in young patients with AIN are limited. METHODS All patients with a diagnosis code of leukopenia, neutropenia, or AIN followed within the outpatient hematology clinic of a single institution from 2014 to 2016 were identified. Patients aged ≤5 years with absolute neutrophil count (ANC) ≤500/µL persisting for ≥3 months, a clinical diagnosis of AIN, and documented resolution of neutropenia were included. Data on clinical management, including infectious outcomes and emergency center (EC) encounters, were collected. RESULTS Forty-three patients with AIN (18 male [42%], median age at diagnosis 12 months) met eligibility criteria. Children were followed by hematology for a median duration of 18 (range, 2-85) months. Diagnostic evaluations were variable. Thirty patients (70%) had ≥ 1 EC encounters for evaluation of isolated fever with a total of 113 EC encounters for the overall cohort. Patients with ANC < 500/µL and isolated fever were admitted for observation, which resulted in 24 hospitalizations in 16 patients. Of 138 blood cultures drawn, two were positive, both later determined to be contaminants. CONCLUSION At a large tertiary care center, no bloodstream infections were identified in a cohort of 43 children with AIN presenting to the EC for assessment of fever. A less-intensive, more cost-effective management paradigm, which continues to prioritize patient safety, among young children with AIN is needed.
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Affiliation(s)
- Susan E Kirk
- Baylor College of Medicine, Department of Pediatrics, Section of Hematology/Oncology, Houston, Texas.,Texas Children's Cancer and Hematology Centers, Houston, Texas
| | - Amanda Bell Grimes
- Baylor College of Medicine, Department of Pediatrics, Section of Hematology/Oncology, Houston, Texas.,Texas Children's Cancer and Hematology Centers, Houston, Texas
| | | | - Jenny M Despotovic
- Baylor College of Medicine, Department of Pediatrics, Section of Hematology/Oncology, Houston, Texas.,Texas Children's Cancer and Hematology Centers, Houston, Texas
| | - Jacquelyn M Powers
- Baylor College of Medicine, Department of Pediatrics, Section of Hematology/Oncology, Houston, Texas.,Texas Children's Cancer and Hematology Centers, Houston, Texas
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Morimoto S, Hirano K, Tabata K, Asaumi H, Morikawa Y, Matsumi Y, Naka S, Matsumoto-Nakano M. Case of autoimmune neutropenia with severe marginal periodontitis. PEDIATRIC DENTAL JOURNAL 2019. [DOI: 10.1016/j.pdj.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Introduction: Neutrophils are the most abundant inflammatory cells in the lungs of patients with chronic lung diseases, especially COPD, yet despite this, patients often experience repeated chest infections. Neutrophil function may be altered in disease, but the reasons are unclear. In chronic disease, sequential pro-inflammatory and pro-repair responses appear distorted. As understanding of neutrophil heterogeneity has expanded, it is suggested that different neutrophil phenotypes may impact on health and disease. Areas covered: In this review, the definition of cellular phenotype, the implication of neutrophil surface markers and functions in chronic lung disease and the complex influences of external, local and genetic factors on these changes are discussed. Literature was accessed up to the 19 July 2019 using: PubMed, US National Library of Medicine National Institutes of Health and the National Centre for Biotechnology Information. Expert opinion: As more is learned about neutrophils, the further we step from the classical view of neutrophils being unrefined killing machines to highly complex and finely tuned cells. Future therapeutics may aim to normalize neutrophil function, but to achieve this, knowledge of phenotypes in humans and how these relate to observed pathology and disease processes is required.
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Affiliation(s)
- Michael J Hughes
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham , Birmingham , UK
| | - Elizabeth Sapey
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham , Birmingham , UK
| | - Robert Stockley
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham , Birmingham , UK
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25
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Oral Manifestations of Autoimmune Neutropenia: A Case Report. J Clin Pediatr Dent 2019; 43:46-50. [PMID: 30289370 DOI: 10.17796/1053-4625-43.1.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Autoimmune neutropenia is a self-limiting condition characterized by the presence of granulocyte-specific autoantibodies. This case report describes a 2-year-old female who presented to the Department of Pediatric Dentistry with a history of oral ulceration, complicated by high temperature, gingival hypertrophy and gingival hemorrhage. These symptoms had precipitated an admission to a district general hospital and diagnosis of viral tonsillitis. The severity of the presentation to the Pediatric Dental Department prompted a review of recent discharge blood investigations, which revealed a neutrophil count of 0.07×109/L(1.0-8.5 ×109/L) indicating severe neutropenia. Urgent referral to Pediatric Hematology resulted in same-day admission and a diagnosis of autoimmune neutropenia was established. The patient was managed with chlorhexidine mouthwash, prophylactic antimicrobial and antifungal medication and granulocyte colony stimulating factor (G-CSF). Neutropenia may present with features exclusive to the oral cavity. Recognition of atypical presentations such as oral ulceration with associated systemic illness may assist in early diagnosis.
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26
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Farruggia P, Fioredda F, Puccio G, Onofrillo D, Russo G, Barone A, Bonanomi S, Boscarol G, Finocchi A, Ghilardi R, Giordano P, Ladogana S, Lassandro G, Luti L, Lanza T, Mandaglio R, Marra N, Martire B, Mastrodicasa E, Motta M, Notarangelo LD, Pillon M, Porretti L, Serafinelli J, Trizzino A, Tucci F, Veltroni M, Verzegnassi F, Ramenghi U, Dufour C. Idiopathic neutropenia of infancy: Data from the Italian Neutropenia Registry. Am J Hematol 2019; 94:216-222. [PMID: 30456824 DOI: 10.1002/ajh.25353] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 10/27/2018] [Accepted: 11/12/2018] [Indexed: 01/13/2023]
Abstract
Autoimmune neutropenia of infancy (AIN) is characterized by low risk of severe infection, tendency to spontaneously resolve and typically onset at ≤4-5 years of age; it is due to auto-antibodies whose detection is often difficult. In case of negativity of 4 antineutrophils autoantibody tests, after having excluded ethnic, postinfection, drug induced, or congenital neutropenia, according to the Italian guidelines the patients will be defined as affected by "idiopathic neutropenia" (IN). We describe the characteristics of 85 IN patients enrolled in the Italian neutropenia registry: they were compared with 336 children affected by AIN. The 2 groups were clinically very similar and the main differences were detection age (later in IN), length of disease (longer in IN) and, among recovered patients, age of spontaneous recovery: the median age at resolution was 2.13 years in AINs and 3.03 years in INs (P = .00002). At bivariate analysis among AIN patients earlier detection age (P = .00013), male sex (P = .000748), absence of leucopenia (P = .0045), and absence of monocytosis (P = .0419) were significantly associated with earlier recovery; in the IN group only detection age (P = .013) and absence of monocytosis (P = .0333) were significant. At multivariate analysis detection age and absence of monocytosis were independently significant (P = 6.7e-05 and 4.4e-03, respectively) in the AIN group, whereas in the IN group only detection age stayed significant (P = .013).
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Affiliation(s)
- Piero Farruggia
- Pediatric Hematology and Oncology Unit; A.R.N.A.S. Ospedale Civico; Palermo Italy
| | - Francesca Fioredda
- Clinical and Experimental Unit G. Gaslini Children's Hospital; Genoa Italy
| | - Giuseppe Puccio
- Department of Sciences for Health Promotion; University of Palermo; Palermo Italy
| | - Daniela Onofrillo
- Pediatric Hematology and Oncology Unit, Department of Hematology; Spirito Santo Hospital; Pescara Italy
| | - Giovanna Russo
- Pediatric Hematology and Oncology Unit, Azienda Policlinico-Vittorio Emanuele; University of Catania; Catania Italy
| | - Angelica Barone
- Department of Pediatric Onco-Hematology; University Hospital; Parma Italy
| | - Sonia Bonanomi
- MBBM Foundation, Department of Pediatrics; University of Milano - Bicocca; Monza Italy
| | - Gianluca Boscarol
- Department of Pediatrics; Central Teaching Hospital Bolzano; Bolzano Italy
| | | | - Roberta Ghilardi
- Department of Pediatrics; Ospedale Maggiore Policlinico IRCCS; Milan Italy
| | - Paola Giordano
- Department of Biomedical Sciences and Human Oncology; Pediatric Section, University "A. Moro" of Bari; Bari Italy
| | - Saverio Ladogana
- Department of Hematology; IRCCS Casa Sollievo della Sofferenza; San Giovanni Rotondo Italy
| | - Giuseppe Lassandro
- Department of Biomedical Sciences and Human Oncology; Pediatric Section, University "A. Moro" of Bari; Bari Italy
| | - Laura Luti
- Pediatric Hematology Oncology; Bone Marrow Transplant, Azienda Ospedaliero Universitaria Pisana, S. Chiara Hospital; Pisa Italy
| | - Tiziana Lanza
- Clinical and Experimental Unit G. Gaslini Children's Hospital; Genoa Italy
| | | | | | - Baldassare Martire
- Pediatric Science and Surgery Department; Pediatric Onco-Hematology Unit, Hospital Policlinico- Giovanni XXIII; Bari Italy
| | - Elena Mastrodicasa
- Pediatric Oncology Hematology Unit; S. Maria Della Misericordia Hospital; Perugia Italy
| | - Milena Motta
- Pediatric Hematology and Oncology Unit, Azienda Policlinico-Vittorio Emanuele; University of Catania; Catania Italy
| | - Lucia Dora Notarangelo
- Onco-Haematology and Bone Marrow Transplantation Unit; Children's Hospital; Brescia Italy
| | - Marta Pillon
- Pediatric Onco-Hematology Department; University of Padova; Padova
| | - Laura Porretti
- Flow Cytometry Service; Laboratory of Clinical Chemistry and Microbiology, IRCCS “Ca‘ Granda” Foundation, Maggiore Hospital Policlinico; Milan Italy
| | | | - Angela Trizzino
- Pediatric Hematology and Oncology Unit; A.R.N.A.S. Ospedale Civico; Palermo Italy
| | - Fabio Tucci
- Department of Pediatric Onco-Hematology; Meyer Children's Hospital; Florence Italy
| | - Marinella Veltroni
- Department of Pediatric Onco-Hematology; Meyer Children's Hospital; Florence Italy
| | - Federico Verzegnassi
- Institute for Maternal and Child Health (I.R.C.C.S) Burlo Garofolo; Trieste Italy
| | - Ugo Ramenghi
- Department of Pediatric and Public Health Sciences; University of Torino; Italy
| | - Carlo Dufour
- Clinical and Experimental Unit G. Gaslini Children's Hospital; Genoa Italy
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Rivalta B, Zama D, Pancaldi G, Facchini E, Cantarini ME, Miniaci A, Prete A, Pession A. Evans Syndrome in Childhood: Long Term Follow-Up and the Evolution in Primary Immunodeficiency or Rheumatological Disease. Front Pediatr 2019; 7:304. [PMID: 31396497 PMCID: PMC6664023 DOI: 10.3389/fped.2019.00304] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 07/08/2019] [Indexed: 12/23/2022] Open
Abstract
Evans syndrome (ES) is a rare but challenging condition, characterized by recurrent and refractory cytopenia episodes. Recent discoveries highlighted that an appropriate diagnostic workup is fundamental to identify an underlying immune dysregulation such as primary immunodeficiencies or a rheumatological disease. We hereby describe clinical features and laboratory results of 12 pediatric patients affected by ES referred to the Pediatric Onco-Hematology Unit of Bologna. Patients experienced a median of four acute episodes of cytopenia with 9 years as median age at the onset of symptoms. In 8/12 (67%) patients an underlying etiology, primary immunodeficiencies, or rheumatological disease was identified. In 4/12 children, other immune manifestations were associated (Thyroiditis, Celiac disease, Psoriasis, Vitiligo, Myositis, Membranoproliferative Glomerulonephritis). ES remained the primary diagnosis in four patients (33%). At a median follow-up time of 4 years, 5/12 (42%) patients revealed a chronic ITP, partially responsive to second line therapy. Immunoglobulin Replacement Therapy (IRT) was effective with a good hematological values control in three patients with a secondary ES (ALPS, CVID, and a patient with Rubinstein Taybi Syndrome and a progressive severe B cell deficiency with hypogammaglobulinemia). Our experience highlights that, in pediatric patients, ES is often only the first manifestation of an immunological or rheumatological disease, especially when cytopenias are persistent or resistant to therapy, with an early-onset or when are associated with lymphadenopathy.
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Affiliation(s)
- Beatrice Rivalta
- Department of Pediatrics, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Daniele Zama
- Department of Pediatrics, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giovanni Pancaldi
- Department of Pediatrics, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Elena Facchini
- Department of Pediatrics, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Maria Elena Cantarini
- Department of Pediatrics, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Angela Miniaci
- Department of Pediatrics, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Arcangelo Prete
- Department of Pediatrics, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Pession
- Department of Pediatrics, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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28
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Abstract
The autoimmune cytopenias are a group of disorders resulting primarily from autoantibody-mediated destruction of blood cells, with variable clinical sequelae depending on the severity and lineage affected. Disease presentation ranges from an asymptomatic finding on a routine full blood count to an acutely unwell patient suffering the clinical consequences of severe anaemia, neutropenia or thrombocytopenia. The cytopenia may be primary or secondary to underlying infectious, immune or malignant processes. Thrombotic thrombocytopenic purpura (TTP) is a distinct, rare but potentially life-threatening entity that classically but not invariably presents with a pentad of acute onset haemolytic anaemia, thrombocytopenia, neurological symptoms, renal impairment and fevers. Autoimmune cytopenias have formed a recognised diagnostic entity for over 150 years yet continue to present a challenge in medical practice due to heterogeneity in clinical presentation and triggering factors, an incomplete understanding of underlying pathophysiology and a lack of evidence-based therapeutic approaches.
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Affiliation(s)
| | - Sue Pavord
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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29
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Wittmann O, Rimon A, Scolnik D, Glatstein M. Outcomes of Immunocompetent Children Presenting with Fever and Neutropenia. J Emerg Med 2017; 54:315-319. [PMID: 29242012 DOI: 10.1016/j.jemermed.2017.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/23/2017] [Accepted: 10/26/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neutropenia may alarm clinicians and prompt extensive evaluation in children with fever, even in immunocompetent patients. OBJECTIVE Our aim was to determine outcomes in previously healthy febrile children presenting to the emergency department with severe neutropenia. METHODS We reviewed data from infants and children aged 3-36 months with fever and severe neutropenia, defined as a peripheral neutrophil count <500 × 103/μL, at our institution between January 1, 2012 and December 31, 2015. We compared our results to those from a similar study of children with a peripheral neutrophil count of 500-1000 × 103/μL. RESULTS Severe neutropenia was recorded in 52 patients; severe bacterial infection (SBI) was found in 1 (1.9%), but none had a positive blood culture. Incidence of SBI was not different from that found in a study of similar patients with moderate neutropenia. CONCLUSIONS Immunocompetent patients with fever and severe neutropenia do not carry a higher risk for SBI compared to patients with fever and moderate neutropenia. Such patients could potentially be followed closely with serial blood counts to ensure bone marrow recovery, without the use of antibiotics.
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Affiliation(s)
- Osnat Wittmann
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Dana-Dwek Children Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayelet Rimon
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Dana-Dwek Children Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dennis Scolnik
- Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Miguel Glatstein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Dana-Dwek Children Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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30
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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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31
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Feng JH, Qian Y. [Advances in research on childhood neutropenia]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:484-489. [PMID: 28407840 PMCID: PMC7389658 DOI: 10.7499/j.issn.1008-8830.2017.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/28/2016] [Indexed: 06/07/2023]
Abstract
Neutrophils, an important type of human immune cells, are involved in host defense against infections. Neutropenia refers to a group of diseases manifesting as a reduction in the absolute value of mature neutrophils and is often accompanied by an increased risk of bacterial infection. According to etiology and pathogenesis, neutropenia is classified into congenital and acquired neutropenia. This article reviews the current research status and advances in the etiology of neutropenia in children. A deep understanding of the etiology of neutropenia helps to improve the diagnosis and treatment of this disease.
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Affiliation(s)
- Jian-Hua Feng
- Department of Pediatric Hematology/Oncology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China.
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32
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Fujita M, Kawabata H, Oka T, Hishizawa M, Kitano T, Kondo T, Yamashita K, Yurugi K, Hirai H, Maekawa T, Takaori-Kondo A. A Rare Case of Adult Autoimmune Neutropenia Successfully Treated with Prednisolone. Intern Med 2017; 56:1415-1419. [PMID: 28566608 PMCID: PMC5498209 DOI: 10.2169/internalmedicine.56.7619] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Autoimmune neutropenia (AIN) is a rare disorder that may cause life-threatening infections. In adults, most cases are secondary to other pathological conditions, and primary AIN is extremely rare. We herein report a case involving a 57-year-old woman diagnosed with AIN. A granulocyte immunofluorescence test detected autoantibodies against human neutrophil antigens in her serum, while various examinations revealed no other causes of neutropenia, suggesting her AIN was primary. She was refractory to granulocyte-colony-stimulating factor but responded to prednisolone. Her neutrophil count remained normal after gradual discontinuation of prednisolone. Diagnostic procedures and optimal treatments for this disorder need to be established.
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Affiliation(s)
- Mari Fujita
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Japan
| | - Hiroshi Kawabata
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Japan
| | - Tomomi Oka
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Japan
| | - Masakatsu Hishizawa
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Japan
| | - Toshiyuki Kitano
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Japan
| | - Tadakazu Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Japan
| | - Kohei Yamashita
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Japan
| | - Kimiko Yurugi
- Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Japan
| | - Hideyo Hirai
- Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Japan
| | - Taira Maekawa
- Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Japan
| | - Akifumi Takaori-Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Japan
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33
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Denstedt EB. Suspected immune-mediated neutropenia and corticosteroid responsive pancytopenia in a Portuguese water dog. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2017; 58:83-86. [PMID: 28042161 PMCID: PMC5157745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
An 8-year-old spayed Portuguese water dog was presented with dysuria, lethargy, and anorexia. A profound neutropenia and pancytopenia were identified. Bone marrow aspirates revealed neutrophilic hyperplasia, a significant left shift, and toxic changes, suggesting immune-mediated destruction as a likely underlying mechanism. Immunosuppressive therapy was instituted and clinical signs improved.
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Abstract
PURPOSE OF REVIEW Neutropenia lasting for at least for 3 months and not attributable to drugs or a specific genetic, infectious, inflammatory, autoimmune or malignant cause is called chronic idiopathic neutropenia (CIN). CIN and autoimmune neutropenia (AIN) are very similar and overlapping conditions. The clinical consequences depend upon the severity of neutropenia, but it is not considered a premalignant condition. RECENT FINDINGS Long-term observational studies in children indicate that the disease often lasts for 3-5 years in children, then spontaneously remits, but it rarely remits in adult cases. The value of antineutrophil antibody testing in both children and adults is uncertain. Most recent data suggest that CIN and AIN are immune-mediated diseases, but there are no new clinical or genetic tests to aid in diagnosis. Treatment with granulocyte colony stimulating factor (G-CSF) is effective to increase blood neutrophils in almost all cases; this treatment is reserved, however, for patients with both neutropenia and evidence of recurrent fevers, inflammatory symptoms and infections. There is little or no evidence to indicate that G-CSF treatment predisposes to myeloid malignancies in this population. SUMMARY It is important to recognize CIN and AIN, the most common causes of chronic neutropenia in both children and adults. If the neutropenia is not severe, that is more than 0.5 × 10/l, most patients can be observed and not treated prophylactically with antibiotics or a growth factor. When neutropenia is severe, treatment with G-CSF is often beneficial.
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Affiliation(s)
- David C. Dale
- University of Washington, Department of Medicine, Seattle, WA
| | - Audrey Anna Bolyard
- Severe Chronic Neutropenia International Registry, University of Washington, Department of Medicine, Seattle, WA
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35
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Newburger PE. Autoimmune and other acquired neutropenias. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2016; 2016:38-42. [PMID: 27913460 PMCID: PMC5380382 DOI: 10.1182/asheducation-2016.1.38] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This educational review addresses the diagnostic evaluation of patients for autoimmune and other forms of acquired neutropenia, including the futility of deconstructing the overlap of chronic "autoimmune," "benign," and "idiopathic" categories. Isolated neutropenias caused by infection, drugs, and immunologic disorders are also addressed. Discussion of management options emphasizes a conservative approach, with largely supportive care for these mostly benign and self-limited disorders.
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Affiliation(s)
- Peter E Newburger
- Departments of Pediatrics and Molecular, Cell, and Cancer Biology, University of Massachusetts Medical School, Worcester, MA
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36
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Affiliation(s)
- Maurizio Miano
- Clinical and Experimental Haematology Unit; Department of Haematology/Oncology; IRCCS Istituto Giannina Gaslini; Genoa Italy
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37
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Celkan T, Koç BŞ. Approach to the patient with neutropenia in childhood. Turk Arch Pediatr 2015; 50:136-44. [PMID: 26568688 DOI: 10.5152/turkpediatriars.2015.2295] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 03/30/2015] [Indexed: 01/29/2023]
Abstract
Neutrophils have an important role in host defense and acute inflammation. It is well known that susceptibility to infection increases when the neutrophil count is low. Neutropenia were classified as mild, moderate and severe according to the neutrophil counts, or acute and chronic depending on the duration of neutropenia, or congenital and acquired according to the mechanism. The patients with neutropenia are clinically different due to underlying mechanism, they have life- threatening infections or no infection may be observed. The most common cause of acquired neutropenia is viral infection, followed by drugs and autoimmune neutropenia. Congenital neutropenia are usually diagnosed by acute and life- threatening invasive bacterial and fungal infections. Immune system disorders and other systemic abnormalities may be accompanied or not. Recent years, novel single gen defects causing congenital neutropenia were defined through advanced genetic techniques. Molecular diagnosis is useful for risk stratification, choice of therapy and prognosis on follow- up. This review was prepared for pediatricians as a guide focused on approach neutropenia, which tests should be performed and when should be referred to a specialist.
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Affiliation(s)
- Tiraje Celkan
- Division of Pediatric Hematology-Oncology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Begüm Şirin Koç
- Division of Pediatric Hematology-Oncology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
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