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Cai Y, Huang Z, Wu B, Wu P, Zhang Y, Lin Y, Wang Q, Liang S, Chen S. Increased nutrition risk is associated with a prolonged negative conversion of viral RNA in children and adolescents with COVID-19. Nutr Clin Pract 2023; 38:1073-1081. [PMID: 37039702 DOI: 10.1002/ncp.10994] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/22/2023] [Accepted: 03/19/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND This study aimed to determine the factors affecting the time to negative conversion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children and adolescents, with particular reference to nutrition risk assessment on admission. METHODS This retrospective observational study was conducted in a sentinel hospital for novel coronavirus in Quanzhou, China. The study population comprised children and adolescents with COVID-19 admitted to the isolation wards between March 25 and April 12, 2022. Based on the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), nutrition risk screening was performed within 24 h of admission. Univariate and multivariate analyses were used to identify independent factors for the time to negative viral RNA conversion. RESULTS A total of 185 patients with confirmed COVID-19 were included in this study. The median time to viral RNA conversion (from the first day of a positive nucleic acid test to the first day of consecutive negative results) was 15 days (IQR 12-18 days), ranging from 4 to 25 days. High nutrition risk (hazard ratio [HR]: 0.543, 95% CI: 0.334-0.881) and fever (HR: 0.663; 95% CI: 0.483-0.910) were independent factors influencing the negative conversion of SARS-CoV-2 RNA. CONCLUSION High nutrition risk and fever were independently associated with delayed viral clearance in children and adolescents with SARS-CoV-2 infection, so these factors should be considered during the treatment plans for infected children and adolescents.
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Affiliation(s)
- Yanliang Cai
- Department of Pediatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhifeng Huang
- Department of Pediatrics, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
| | - Bin Wu
- Department of Pediatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Peilin Wu
- Department of Pediatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yifei Zhang
- Department of Pediatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yueli Lin
- Department of Pediatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qingwen Wang
- Department of Pediatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Shishan Liang
- Department of Pediatrics, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
| | - Suqing Chen
- Department of Pediatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Nguyen SN, Vu LT, Vu QV, Tran TT, Dinh VTT. Clinical Epidemiology Characteristics and Etiology of Febrile Neutropenia in Children: Analysis of 421 Cases. Hematol Rep 2022; 14:245-252. [PMID: 35997401 PMCID: PMC9397012 DOI: 10.3390/hematolrep14030034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/22/2022] [Accepted: 07/19/2022] [Indexed: 01/11/2023] Open
Abstract
The congenital immune system includes neutrophils, which perform a variety of functions. Congenital and acquired neutropenia are rare illnesses with an underestimated prevalence in children. The aim of this study is to examine the epidemiology and etiology of febrile neutropenia in children at Haiphong Children’s Hospital, Haiphong, Vietnam. Methods: A cross-sectional study was carried out on 421 febrile neutropenia children. Clinical and laboratory characteristics were examined. Results: The median age (IQR) was 25.0 (12.5–59.5) months. The male-to-female ratio was 1.35/1. There were twice as many children living in the suburbs (66.98%) as in urban areas (33.02%). The mean (SD) temperature at admission was 38.50 ± 0.59 °C. Diagnosed causes associated with neutropenia included acute respiratory infections 250 (59.45%), gastrointestinal infections 68 (16.1%), erythema 37 (8.79%), acute leukemia 15 (3.56%), urinary tract infection 5 (1.19%), and encephalitis/meningitis 4 (0.95%). Viral etiology accounted for 61.52% (259): influenza type A—50.19% (130), influenza type B—31.27% (81), dengue virus—14.67% (38), measles virus 1—93% (5), rotavirus—1.54% (4), and EBV—0.4% (1). Twenty-five patients (5.94%) were found to have bacteria in their cultures, with Streptococcus pneumonia being the most common (eight patients; 32%). Conclusions: Febrile neutropenia was common in children under 2 years old. Primary clinical manifestations were acute upper respiratory tract infections, and viruses most commonly caused febrile neutropenia. Further studies with larger sample sizes are needed to determine the cause of febrile neutropenia.
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3
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Pulcini CD, Lentz S, Saladino RA, Bounds R, Herrington R, Michaels MG, Maurer SH. Emergency management of fever and neutropenia in children with cancer: A review. Am J Emerg Med 2021; 50:693-698. [PMID: 34879488 DOI: 10.1016/j.ajem.2021.09.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Care of pediatric cancer patients is increasingly being provided by physicians in community settings, including general emergency departments. Guidelines based on current evidence have standardized the care of children undergoing chemotherapy or hematopoietic stem cell transplantation (HSCT) presenting with fever and neutropenia (FN). OBJECTIVE This narrative review evaluates the management of pediatric patients with cancer and neutropenic fever and provides comparison with the care of the adult with neutropenic fever in the emergency department. DISCUSSION When children with cancer and FN first present for care, stratification of risk is based on a thorough history and physical examination, baseline laboratory and radiologic studies and the clinical condition of the patient, much like that for the adult patient. Prompt evaluation and initiation of intravenous broad-spectrum antibiotics after cultures are drawn but before other studies are resulted is critically important and may represent a practice difference for some emergency physicians when compared with standardized adult care. Unlike adults, all high-risk and most low-risk children with FN undergoing chemotherapy require admission for parenteral antibiotics and monitoring. Oral antibiotic therapy with close, structured outpatient monitoring may be considered only for certain low-risk patients at pediatric centers equipped to pursue this treatment strategy. CONCLUSIONS Although there are many similarities between the emergency approach to FN in children and adults with cancer, there are differences that every emergency physician should know. This review provides strategies to optimize the care of FN in children with cancer in all emergency practice settings.
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Affiliation(s)
- Christian D Pulcini
- Division of Emergency Medicine, Department of Surgery and Pediatrics, University of Vermont Larner College of Medicine, Burlington, VT, United States of America.
| | - Skyler Lentz
- Division of Emergency Medicine and Critical Care, Department of Surgery and Medicine, University of Vermont Larner College of Medicine, Burlington, VT, United States of America
| | - Richard A Saladino
- Division of Pediatric Emergency Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
| | - Richard Bounds
- Division of Emergency Medicine, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT, United States of America.
| | - Ramsey Herrington
- Division of Emergency Medicine, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT, United States of America.
| | - Marian G Michaels
- Division of Infectious Diseases, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
| | - Scott H Maurer
- Division of Hematology/Oncology, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
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4
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Litao MKS, Alvarez AG, Shah B. Pre-treatment Neutropenia in Children and Adolescents with Autoimmune Hyperthyroidism. J Clin Res Pediatr Endocrinol 2021; 13:263-268. [PMID: 33261249 PMCID: PMC8388046 DOI: 10.4274/jcrpe.galenos.2020.2020.0184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Neutropenia can occur in untreated autoimmune hyperthyroidism (AIH) or in association with treatment with the anti-thyroid drug, methimazole (MMI). Starting MMI in children and adolescents with AIH and pre-existing neutropenia could thus be worrisome. The aim was to describe the prevalence of neutropenia in pediatric AIH, prior to antithyroid drug therapy and to assess the effect of antithyroid drugs on neutrophil count. METHODS Patients with AIH attending a pediatric endocrinology clinic were retrospectively reviewed. Absolute neutrophil count (ANC) data at presentation and during anti-thyroid treatment for up to 24 weeks was collected. AIH was defined as elevated free thyroxine (fT4) or free tri-iodothyronine (fT3), suppressed thyroid stimulating hormone, and positive thyroid autoantibodies. Neutropenia was defined as ANC <1500 cells/μL. RESULTS Thirty-one patients (71% female) were included with a median interquartile range (IQR) age of 14.71 (11.89-17.10) years. Neither fT4 nor fT3 levels correlated with ANC at presentation (rs=0.22, p=0.24 and rs=0.13, p=0.54, respectively). 26/31 (84%) had normal baseline ANC. None developed neutropenia with thionamides. 5/31 (16%) had baseline neutropenia (median ANC 1,200/μL; IQR 874-1200). Four of these five started MMI at diagnosis while one was started on propranolol only but MMI was started one week later. All five normalized ANC within 24 weeks. CONCLUSION In this cohort, 16% of AIH patients had neutropenia at presentation, but this resolved in the short term and did not worsen with thionamides. Thionamides may be used with caution in these patients with close monitoring of blood counts.
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Affiliation(s)
- Melissa Kaori S. Litao
- New York University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, New York, USA
| | - Ana Gutierrez Alvarez
- New York University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, New York, USA
| | - Bina Shah
- New York University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, New York, USA,* Address for Correspondence: New York University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, New York, USA E-mail:
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5
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O'Brien SH, Badawy SM, Rotz SJ, Shah MD, Makarski J, Bercovitz RS, Hogan MJS, Luchtman-Jones L, Panepinto JA, Priola GM, Witmer CM, Wolfson JA, Yee M, Hicks LK. The ASH-ASPHO Choosing Wisely Campaign: 5 hematologic tests and treatments to question. Pediatr Blood Cancer 2021; 68:e28967. [PMID: 34047047 DOI: 10.1002/pbc.28967] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Choosing Wisely is a medical stewardship and quality-improvement initiative led by the American Board of Internal Medicine Foundation in collaboration with leading medical societies in the United States. The American Society of Hematology (ASH) has been an active participant in the Choosing Wisely project. In 2019, ASH and the American Society of Pediatric Hematology/Oncology (ASPHO) formed a joint task force to solicit, evaluate, and select items for a pediatric-focused Choosing Wisely list. By using an iterative process and an evidence-based method, the ASH-ASPHO Task Force identified 5 hematologic tests and treatments that health care providers and patients should question because they are not supported by evidence, and/or they involve risks of medical and financial costs with low likelihood of benefit. The ASH-ASPHO Choosing Wisely recommendations are as follows: (1) avoid routine preoperative hemostatic testing in an otherwise healthy child with no previous personal or family history of bleeding, (2) avoid platelet transfusion in asymptomatic children with a platelet count 10 × 103 /μL unless an invasive procedure is planned, (3) avoid thrombophilia testing in children with venous access-associated thrombosis and no positive family history, (4) avoid packed red blood cells transfusion for asymptomatic children with iron deficiency anemia and no active bleeding, and (5) avoid routine administration of granulocyte colony-stimulating factor for prophylaxis of children with asymptomatic autoimmune neutropenia and no history of recurrent or severe infections. We recommend that health care providers carefully consider the anticipated risks and benefits of these identified tests and treatments before performing them.
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Key Words
- COAGULATION/coagulation, COAGULATION/venous thromboembolism prophylaxis, diagnosis, and treatment, PLATELETS/disorders of platelets, PHAGOCYTES/neutrophils, RED CELLS/anemia
- clinical: nutritional
- iron, cobalamin, folate, anemia, autoimmune neutropenia, iron deficiency, platelets, pre-operative coagulation, thrombophilia
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Affiliation(s)
- Sarah H O'Brien
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital/The Ohio State University, Columbus, OH
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Seth J Rotz
- Department of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, OH
| | - Mona D Shah
- Division of Hematology and Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Julie Makarski
- Independent consultant methodologist, Hamilton, ON, Canada
| | - Rachel S Bercovitz
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mary-Jane S Hogan
- Department of Pediatrics, Section of Hematology and Oncology, Yale School of Medicine, New Haven, CT
| | - Lori Luchtman-Jones
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.,Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Julie A Panepinto
- Division of Pediatric Hematology/Oncology, Children's Wisconsin/Medical College of Wisconsin, Milwaukee, WI
| | - Ginna M Priola
- Division of Pediatric Hematology/Oncology, Mission Children's Hospital, Asheville, NC
| | - Char M Witmer
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Julie A Wolfson
- Division of Pediatric Hematology-Oncology, Institute for Cancer Outcomes and Survivorship, University of Alabama, Birmingham, AL
| | - Marianne Yee
- Division of Hematology/Oncology, Department of Pediatrics, Emory University, Atlanta, GA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
| | - Lisa K Hicks
- Division of Hematology/Oncology, St. Michael's Hospital, Toronto, ON, Canada
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Muzaffer MA, Abdelgalil AA. Tocilizumab in management of refractory juvenile idiopathic arthritis, 10 years of experience at tertiary university hospital. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2021. [DOI: 10.1186/s43166-021-00074-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Juvenile idiopathic arthritis (JIA) is the most prevalent pediatric rheumatic disorder. Progress in modalities of therapy improves the disease outcome. We aimed to determine the efficacy and safety of tocilizumab (TCZ) in the management of systemic (sJIA) and polyarticular (pJIA) in children who are resistant to conventional as well as other biological therapies. In this retrospective study, we selected JIA patients according to the International League of Association for Rheumatology (ILAR) criteria and were treated with TCZ. Response to TCZ was assessed using Juvenile Arthritis Disease Activity Score-10 (JADAS-10) and also outcomes were assessed according to the American College of Rheumatology (ACR) remission criteria. Safety of the drug was assessed by documenting possibly related adverse effects (AE). Statistical analysis using SPSS version 25 with statistical significance is considered if p ≤ 0.05. We included 16 JIA patients aged ≤ 18 years but 2 of them were excluded as they developed severe reaction during the TCZ 1st dose, so finally, 14 patients were included.
Results
The median age of our patients was 12 years. Of these 14 patients, 9 (64.3%) had sJIA and 5 (35.7%) had pJIA. TCZ use led to significant improvement in the JADAS-10 from mean 22.4 (± 7.9) when it was initially assessed and then 3, 6, 12, and 24 months after TCZ initiation with means 5.7 (± 3.9), 4.4 (± 3.7), 3.5 (± 3.1), and 2.7 (± 2.2), (P = 0.001, 0.001, 0.005, 0.012), respectively. Five patients exhibited TCZ possibly expected side effects. Neutropenia and infusion-related reactions were the most frequent AE.
Conclusions
Tocilizumab seems to be generally effective and safe drug in the management of sJIA and pJIA especially in cases refractory to conventional as well as other biologic agents.
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7
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Arslantaş E, Ayçiçek A, Türkoğlu R, Tahtakesen TN, Uysalol EP, Bayram C, Akici F, Şanlı K, Özdemir N. Clinical Picture, Outcome, and Risk of Serious Bacterial Infections in Immunocompetent Previously Healthy Neutropenic Children. J PEDIAT INF DIS-GER 2021. [DOI: 10.1055/s-0041-1726869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Abstract
Objective In childhood, the cause of neutropenia is a challenging diagnosis with a spectrum of underlying etiologies. This study was performed to investigate the clinical picture and the outcomes associated with the new onset neutropenia in previously healthy children, and to determine the risk of serious bacterial infection (SBI) in those patients.
Methods Patients presenting between January 2018 and September 2018 with an absolute neutrophil count (ANC) <1,500/μL were retrospectively evaluated. Patients with known underlying chronic disease or immunosuppressive conditions were excluded. Neutropenia was categorized into three groups: mild, 1,000–1,500/μL; moderate, 500 to <1,000/μL; and severe <500/μL.
Results A total of 423 patients were investigated. There were 156 (36.9%), 193 (45.6%), and 74 (17.5%) patients in the mild, moderate, and severe groups, respectively. Bacteremia was detected in one (0.02%) patient and SBI in 21 (4.9%) patients. No significant correlation was found between the incidence of SBI and bacterial infection rate among different age groups (p > 0.05). The incidence of SBI varied significantly according to the severity of the neutropenia (p = 0.012) and as the neutropenia became more severe, the incidence of SBI increased (p = 0.015).
Conclusion The clinical outcome of neutropenia in previously healthy and immunocompetent children is generally good with a relatively low incidence of SBI. We suggest that aggressive therapy and frequent follow-up should be reserved for previously healthy neutropenic children with SBI.
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Affiliation(s)
- Esra Arslantaş
- Department of Pediatric Hematology and Oncology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Ali Ayçiçek
- Department of Pediatric Hematology and Oncology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Recep Türkoğlu
- Department of Pediatrics, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Tuba Nur Tahtakesen
- Department of Pediatric Hematology and Oncology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Ezgi Paslı Uysalol
- Department of Pediatric Hematology and Oncology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Cengiz Bayram
- Department of Pediatric Hematology and Oncology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Ferhan Akici
- Department of Pediatric Hematology and Oncology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Kamuran Şanlı
- Department of Microbiology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Nihal Özdemir
- Department of Pediatric Hematology and Oncology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
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8
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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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9
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Tsai MH. Acute neutropenia in young children with immunocompetency: Is it a sign of benign viral infection or a risk of severe bacterial infection? Pediatr Neonatol 2021; 62:1-2. [PMID: 33317993 DOI: 10.1016/j.pedneo.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ming-Han Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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10
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Mika B, Pełka M, Tkacz E. Mathematical modeling of the neutrophil production process supported by administration of glycoprotein. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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11
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Larouche V, Pelland-Marcotte MC, Blanchet MÈ, Simonyan D, Bélanger RE. The Management of Young Children With a Likely Infectious Condition Presenting Moderate to Severe Neutropenia. J Pediatr Hematol Oncol 2020; 42:e778-e782. [PMID: 32079987 DOI: 10.1097/mph.0000000000001749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The objective of this study was to describe the outcome of healthy children presenting with newly-diagnosed neutropenia in an infectious context. RESULTS A total of 184 episodes of neutropenia were included in children 3 months to 5 years of age. There were 118 (64%) episodes of moderate neutropenia and 66 (36%) of severe neutropenia (SN). SN episodes were more likely related to intensification of antibiotic regimen used and further investigations. The median duration of neutropenia was 8.5 days. Chronic benign neutropenia occurred in 7 (4%) patients. CONCLUSION SN led to intensification of antibiotic therapy, but no children encountered an unfavorable outcome and the neutropenia episodes were short-lived.
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Affiliation(s)
| | | | | | - David Simonyan
- Clinical and Evaluative Research Platform, Research Center, CHU de Québec-Université Laval
| | - Richard E Bélanger
- Department of Pediatrics.,Population Health and Optimal Health Practices Research Branch, CHU de Québec Research Centre, Québec City, QC, Canada
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12
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Linko-Parvinen AM, Turkia H. Reporting Sysmex XN Absolute Neutrophil Count in Samples with Leukocyte Analyzer Flagging. Lab Med 2020; 52:168-173. [PMID: 32816034 DOI: 10.1093/labmed/lmaa058] [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] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To provide faster laboratory data reporting, we evaluated the accuracy of Sysmex XN (Sysmex Inc, Kobe, Japan) absolute neutrophil count (ANC) in the presence of analyzer flagging. METHODS Sysmex XN and manual microscopy ANC were compared with 80 autovalidated control specimens and with 280 study specimens with analyzer flagging regarding immature granulocytes (IG) >3% or other leukocyte abnormalities. Specimens with ambiguous neutrophil clusters were excluded. RESULTS A slight positive overall method bias was seen for Sysmex XN compared to manual microscopy (n = 280), 0.025 (95% confidence interval [CI], -0.023 to 0.069) × 109/L. With IG > 10% (n = 123) the bias was larger, but not clinically significant, 0.17 (95% CI, 0.060-0.25) × 109/L. No clinically significant difference was seen in neutropenic (ANC < 1.5 × 109/L) specimens (n = 91), 0.070 (95% CI, -0.013 to 0.14) × 109/L. CONCLUSION These data indicate that Sysmex XN ANC can be reported in the presence of certain analyzer flagging to improve patient care.
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Affiliation(s)
| | - Heidi Turkia
- Laboratory of Haematology, Tykslab, Laboratory Division, Turku University Hospital, Turku, Finland
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13
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Cohen A, Owolabi FS, Dowdell-Smith CP, Laufman J, Iacobas I, Bass L, Foradori D. Weakness, Anemia, and Neutropenia in a 9-Year-Old Girl With Influenza. Pediatrics 2020; 145:peds.2019-2574. [PMID: 32144121 DOI: 10.1542/peds.2019-2574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2019] [Indexed: 11/24/2022] Open
Abstract
A previously healthy 9-year-old immigrant girl from Mexico was evaluated in the emergency department (ED) with one week of fatigue, fevers, rhinorrhea, and cough. She initially presented to her primary pediatrician, where a complete blood count revealed neutropenia, prompting referral to the ED. In the ED, she was found to be influenza A-positive. Because of dehydration, she received intravenous fluids and was admitted to the pediatric hospital medicine service. After 2 days, influenza symptoms improved, and oral intake increased. However, she was noted to have decreased bilateral lower-extremity strength, absent Achilles reflexes, decreased lower-extremity sensation and proprioception, a positive result on the Romberg sign, and abnormal heel-to-shin testing results. These findings prompted an urgent neurology consultation. After extensive imaging, laboratory evaluation, and further consultations, a diagnosis was established.
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Affiliation(s)
- Adam Cohen
- Texas Children's Hospital, Houston, Texas; .,Baylor College of Medicine, Houston, Texas; and
| | - Funmilola S Owolabi
- Texas Children's Hospital, Houston, Texas.,Baylor College of Medicine, Houston, Texas; and
| | - Cicely P Dowdell-Smith
- Texas Children's Hospital, Houston, Texas.,Baylor College of Medicine, Houston, Texas; and
| | | | - Ionela Iacobas
- Texas Children's Hospital, Houston, Texas.,Baylor College of Medicine, Houston, Texas; and
| | - Lanessa Bass
- Texas Children's Hospital, Houston, Texas.,Baylor College of Medicine, Houston, Texas; and
| | - Dana Foradori
- Texas Children's Hospital, Houston, Texas.,Baylor College of Medicine, Houston, Texas; and
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14
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Abstract
Leukocytes, or white blood cells, are part of the innate immune system that defends against infectious and foreign agents. In pediatrics, it is important to use age-specific laboratory values when interpreting results. Infections are the most common cause of leukocytosis or leukopenia in children. Symptoms suggestive of more serious etiologies include persistent fevers, weight loss, bruising, fatigue, and adenopathy. Neutropenia is of special importance in pediatrics due to associations of severe neutropenia with genetic syndromes and overlapping presentations with primary immunodeficiencies. Although the discovery of novel genetic mutations has aided the hematologist/oncologist and the immunologist in managing these conditions, the relationship between clinical phenotype and mutation is still not well known. [Pediatr Ann. 2020;49(1):e17-e26.].
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15
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Hashmi SK, Bergstrom K, Bertuch AA, Despotovic JM, Muscal E, Xia F, Bi W, Marcogliese A, Diaz R. PSTPIP1-associated myeloid-related proteinemia inflammatory syndrome: A rare cause of childhood neutropenia associated with systemic inflammation and hyperzincemia. Pediatr Blood Cancer 2019; 66:e27439. [PMID: 30198636 DOI: 10.1002/pbc.27439] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 07/27/2018] [Accepted: 08/06/2018] [Indexed: 11/09/2022]
Abstract
Neutropenia in pediatric patients can be due to a variety of disorders. We describe two patients who underwent extensive evaluation over many years for arthralgias and moderate neutropenia of unclear etiology. Genetic testing identified a pathogenic variant in PSTPIP1 (proline-serine-threonine phosphatase-interacting protein 1) in both patients. Markedly elevated inflammatory markers and zinc levels confirmed the rare diagnosis of PSTPIP1-associated myeloid-related proteinemia inflammatory (PAMI) syndrome, tailoring treatment. Neutropenia is common in patients with PAMI syndrome. Unique mutations seen in PAMI syndrome may account for the specific phenotypic features of this disorder.
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Affiliation(s)
- Saman K Hashmi
- Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, Texas
| | - Katie Bergstrom
- Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, Texas
| | - Alison A Bertuch
- Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, Texas
| | - Jenny M Despotovic
- Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, Texas
| | - Eyal Muscal
- Department of Pediatrics, Section of Immunology/Allergy/Rheumatology, Baylor College of Medicine, Houston, Texas
| | - Fan Xia
- Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Weimin Bi
- Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | | | - Rosa Diaz
- Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, Texas
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16
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Ali F, Alsayegh F, Sharma P, Waheedi M, Bayoud T, Alrefai F. White blood cell subpopulation changes and prevalence of neutropenia among Arab diabetic patients attending Dasman Diabetes Institute in Kuwait. PLoS One 2018; 13:e0193920. [PMID: 29547660 PMCID: PMC5856345 DOI: 10.1371/journal.pone.0193920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 02/21/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The effects of diabetes mellitus on the differential white blood cell count are not widely studied in the Arab populations. The objective of this cross-sectional, retrospective study is to assess the influence of chronic diabetes mellitus on white blood cell counts, absolute neutrophil (ANC) and lymphocyte counts (ALC) as well as the prevalence of benign ethnic neutropenia among Arabs attending the Dasman Diabetes Institute (DDI) in Kuwait. METHODS AND FINDINGS 1,580 out of 5,200 patients registered in the DDI database qualified for our study. Age, gender, HbA1c and creatinine levels, estimated glomerular filtration rate as well as average WBC, ANC and ALC levels, presence of diabetes-associated complications and anti-diabetic medications were analyzed. Our results showed the mean value of the WBC was 7.6 ± 1.93 x 109/L (95% CI: 2.95-17.15). The mean ANC was 4.3 x 109/L (95% CI: 0.97-10.40) and mean ALC was 2.5 x 109/L (95% CI: 0.29-10.80). Neutropenia (ANC: <1.5 x 109/L) was detected in fifteen patients (0.94%). Six patients (0.4%) fulfilled the definition of lymphopenia (ALC < 1 x109/L). Patients with an HbA1c ≥ 7% and those taking at least 3 anti-diabetic medications showed higher values for ANC and ALC. Patients with diabetes-associated neuropathy or nephropathy displayed higher mean ANC values. Our study was limited by overrepresentation of patients over 50 years old compared to those under 50 as well as selection bias given its retrospective nature. CONCLUSIONS Our study showed that patients with poorly controlled diabetes displayed higher ANC and ALC levels. In addition, patients with DM-associated complications showed higher ANC levels. This finding would suggest that DM exerts a pro-inflammatory influence on differential WBC counts. Our study also showed that the prevalence of benign ethnic neutropenia was lower than previously reported in other studies.
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Affiliation(s)
- Fatima Ali
- Faculty of Medicine, Health Science Center–Kuwait University, Al-Jabriya, Kuwait
| | - Faisal Alsayegh
- Faculty of Medicine, Health Science Center–Kuwait University, Al-Jabriya, Kuwait
| | - Prem Sharma
- Faculty of Medicine, Health Science Center–Kuwait University, Al-Jabriya, Kuwait
| | - Mohammad Waheedi
- Faculty of Pharmacy, Health Science Center–Kuwait University, Al-Jabriya, Kuwait
| | - Tania Bayoud
- Faculty of Pharmacy, Health Science Center–Kuwait University, Al-Jabriya, Kuwait
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17
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Cheon E, Hwang I, Jung HJ, Park JE. Clinical Characteristics of Severe Neutropenia in Children. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2017. [DOI: 10.15264/cpho.2017.24.2.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Eunjae Cheon
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Inchan Hwang
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Joo Jung
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Jun Eun Park
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
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18
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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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19
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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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20
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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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21
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Abstract
PURPOSE OF REVIEW Neutropenia absolute neutrophil count (ANC) less than 1.5 × 10(9)/l is a common hematological finding, and severe neutropenia, that is, ANC less than 0.5 × 10(9)/l is a well known risk factor for susceptibility to bacterial infections. This review provides a succinct clinical approach to the diagnosis and treatment of neutropenia with specific recommendations on the treatment of severe chronic neutropenia with the myeloid growth factor, granulocyte colony-stimulating factor (G-CSF). RECENT FINDINGS Experts agree that patients with acute febrile neutropenia should be treated with antibiotics and that patients at high risk of severe neutropenia (>20% risk) after myelosuppressive chemotherapy should be treated prophylactically with a myeloid growth factor, usually G-CSF. The diversity of causes and consequences of chronic neutropenia make the diagnosis and management of these patients more complicated. SUMMARY The review provides a stepwise approach to neutropenia focusing first on reaching a provisional diagnosis and treatment plan then steps to a final diagnosis. It also provides specific recommendations on the treatment of severe chronic neutropenia with G-CSF.
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22
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Palmblad J, Nilsson CC, Höglund P, Papadaki HA. How we diagnose and treat neutropenia in adults. Expert Rev Hematol 2016; 9:479-87. [PMID: 26778239 DOI: 10.1586/17474086.2016.1142867] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Neutropenias (NPs), being acute and often transient, or chronic, range from life-threatening conditions with very low absolute neutrophil blood counts (ANC) to disorders characterized by only mild NP and of no obvious significance for health. Many are caused by genetic variations/mutations, e.g. the benign familial NP and the chronic severe NPs (e.g. Kostmann disease). Some of the latter are associated with various bodily malformations. Many of the mild-to-moderate NPs are signs of underlying disorders that need specialized treatments (e.g. HIV, hepatitis, autoimmune disorders, the large granular lymphocyte syndrome). We provide here means for the evaluation of a previously unknown NP, suggest a triage and treatments.
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Affiliation(s)
- Jan Palmblad
- a Departments of Medicine and Hematology , The Karolinska Institutet, Karolinska University Hospital Huddinge , Stockholm , Sweden
| | - Christer C Nilsson
- a Departments of Medicine and Hematology , The Karolinska Institutet, Karolinska University Hospital Huddinge , Stockholm , Sweden
| | - Petter Höglund
- b Center for Hematology and Regenerative Medicine (HERM), Departments of Hematology and Clinical Immunology and Transfusion Medicine , Karolinska University Hospital Huddinge , Stockholm , Sweden
| | - Helen A Papadaki
- c Department of Hematology , University of Crete Medical School , Heraklion , Greece
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23
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Patient and Parent Identified Quality-of-Life Symptoms of Isolated Severe Chronic Neutropenias. REHABILITATION ONCOLOGY 2016. [DOI: 10.1097/01.reo.0000475879.81515.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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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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25
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Shaver AK, Walkovich K, Connelly JA. Recurrence of Neonatal Lupus Post-Cord Blood Transplant for Severe Congenital Neutropenia. Pediatrics 2015. [PMID: 26195545 DOI: 10.1542/peds.2014-3448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Neonatal lupus erythematosus (NLE) is a rare autoimmune disorder associated with transplacental migration of maternal autoantibodies against SS-A (Ro) or SS-B (La) antigens that results in cardiac, hepatic, cutaneous, and hematologic manifestations. Although NLE-associated neutropenia is considered transient and benign, neutropenia caused by severe congenital neutropenia (SCN) is life-threatening. Diagnosing a complicated picture of neonatal neutropenia can be challenging because there are many overlapping features between the acquired and inherited etiologies. This article highlights this diagnostic challenge with a case of delayed diagnosis of SCN due to an initial diagnosis of concurrent NLE. Secondary to SCN refractory to granulocyte colony-stimulating factor, our patient underwent a matched sibling cord blood transplant. Posttransplant, the patient developed recurrence of NLE symptoms, representing the first case of maternally transferred autoantibodies causing symptoms in a cord blood recipient. This novel finding prompted a review of the standards for collecting, processing, and storing of cord blood donations. This article also discusses the importance of physician familiarity with the differences and similarities between publicly and privately banked cord blood donations to adequately counsel expectant parents.
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Affiliation(s)
- Ashley K Shaver
- University of Michigan Medical School, Ann Arbor, Michigan; and
| | - Kelly Walkovich
- University of Michigan Medical School, Ann Arbor, Michigan; and Division of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, Michigan
| | - James A Connelly
- University of Michigan Medical School, Ann Arbor, Michigan; and Division of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, Michigan
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26
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Gaudichon J, Cornet E, Minckes O, Bodet D. [Fortuitously discovered neutropenia in children: diagnosis and follow-up]. Arch Pediatr 2015; 22:822-9. [PMID: 26142763 DOI: 10.1016/j.arcped.2015.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 03/14/2015] [Accepted: 05/12/2015] [Indexed: 12/15/2022]
Abstract
Neutropenia seems to be quite frequent in current pediatric practice and can confuse the clinician since it may result from a severe cause. The aim of this study was to provide a prospective description of episodes of neutropenia in children to assess its clinical relevance in a general pediatric cohort consulting and/or hospitalized in a French university hospital. In this prospective observational and monocentric study conducted from April 2012 to April 2013, we included all the patients under 18 years of age who presented neutropenia (defined as an absolute neutrophil count [ANC] below 1×10(9)/L before 1 year of age and below 1.5×10(9)/L beyond) on a whole blood count (WBC) performed in our hospital. Patients treated with chemotherapy were not included. Medical records were regularly checked for at least 1 year after inclusion, and clinical and biological data were collected prospectively to compare transient episodes of neutropenia (<3 months) with persistent episodes of neutropenia (>3months). Of 55,018 consultations and 13,967 hospitalizations (chemotherapy excluded), 8966 blood counts were performed and 250 episodes of neutropenia were found in 238 patients. Data concerning clinical progression were available in 195 cases of which 136 had at least one subsequent WBC. Two hundred thirty-one episodes corresponded to new episodes, while neutropenia preexisted before inclusion in the others. The median follow-up was 12.8 months. Most episodes of neutropenia occurred in children <2 years of age (52%), with a median age of 22.2 months. Mean ANC was 0.943×10(9)/L (±0.340) and a few episodes of neutropenia were below 0.5×10(9)/L (9.2%). Neutropenia persisted more than 3 months in only 13.2% of cases. When neutropenia was below 0.5×10(9)/L, it significantly persisted (RR=3.08; 95% CI [1.31-7.22]). Other factors associated with persistent neutropenia were thrombocytopenia, monocytopenia, a CRP more than 70mg/L, significant abnormality on the clinical exam, and age over 24 months. However, multivariate analysis showed that only an ANC below 0.5×10(9)/L was significantly associated with persistence. While etiology could not be determined in 32% of cases, neutropenia resulted mostly from infectious causes (37.8%), with other causes being more anecdotal. The majority of infectious episodes of neutropenia were viral (90.3%). Like other studies, this investigation suggests that most episodes of neutropenia concern young children, are transient, are benign and often due to infectious diseases. Although it may not reflect the medullar stock or the real capacity of neutrophils to fight bacterial infections, it seems that neutropenia below 0.5×10(9)/L is more likely to persist and be complicated, as previous studies also suggest. To conclude, neutropenia is not exceptional in children and, even if it often results from viral infections and mostly evolves favorably, the clinician should closely monitor these patients, especially when neutrophils are below 0.5×10(9)/L.
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Affiliation(s)
- J Gaudichon
- Pôle femme-enfant-hématologie, unité d'onco-immuno-hématologie pédiatrique, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France.
| | - E Cornet
- Laboratoire d'hématologie-cytologie, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - O Minckes
- Pôle femme-enfant-hématologie, unité d'onco-immuno-hématologie pédiatrique, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - D Bodet
- Pôle femme-enfant-hématologie, unité d'onco-immuno-hématologie pédiatrique, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
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27
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Ye Y, Carlsson G, Karlsson-Sjöberg JMT, Borregaard N, Modéer TU, Andersson ML, Pütsep KLA. The antimicrobial propeptide hCAP-18 plasma levels in neutropenia of various aetiologies: a prospective study. Sci Rep 2015; 5:11685. [PMID: 26119962 PMCID: PMC4484407 DOI: 10.1038/srep11685] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 06/02/2015] [Indexed: 12/11/2022] Open
Abstract
The underlying cause of neutropenia may be difficult to determine due to similar clinical presentation in many neutropenic conditions. The neutrophil protein hCAP-18 (pro-LL-37) is a major component of neutrophil secondary granules and in this prospective study we assessed the use of hCAP-18 levels in blood plasma for differential diagnosis of neutropenic patients (n = 133) of various aetiologies. Plasma levels of hCAP-18 were determined using immunoblot and ELISA. Patients with severe congenital neutropenia (n = 23) presented with the lowest levels of plasma hCAP-18 and differential diagnostic accuracy revealed high sensitivity (100%) and specificity (98.8%) for hCAP-18 ELISA. The correlation coefficient of the hCAP-18 ELISA versus immunoblotting was (R = 0.831) and that of the peptide LL-37 ELISA versus immunoblotting was (R = 0.405) (P < 0.001). Plasma hCAP-18 levels thus displayed high diagnostic value in differential diagnosis of chronic neutropenia. Neutropenic patients with Shwachman-Diamond syndrome, Barth syndrome, Cohen syndrome, acute myeloid leukaemia and specific granule deficiency presented with reduced plasma hCAP-18 levels as well. The blood plasma level of hCAP-18 was thus low in conditions in which the neutrophil antibacterial propeptide hCAP-18 is deficient, i.e. severe congenital neutropenia and neutrophil-specific granule deficiency, and in conditions in which bone marrow myelopoiesis is negatively affected.
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Affiliation(s)
- Ying Ye
- Division of Paediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
- School and Hospital of Stomatology, Peking University, Beijing, China
| | - Göran Carlsson
- Childhood Cancer Research Unit, Department of Women’s and Children’s Health, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | - Niels Borregaard
- The Granulocyte Research Laboratory, Department of Haematology, National University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Thomas U. Modéer
- Division of Paediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Mats L. Andersson
- Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Katrin L-A. Pütsep
- Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
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28
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Palmblad J, Dufour C, Papadaki HA. How we diagnose neutropenia in the adult and elderly patient. Haematologica 2015; 99:1130-3. [PMID: 24986874 DOI: 10.3324/haematol.2014.110288] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Jan Palmblad
- Department of Medicine and Hematology, The Karolinska Institutet at Huddinge University Hospital, Stockholm, Sweden, and SWG on Granulocytes and Monocytes of the EHA
| | - Carlo Dufour
- Clinical and Exprimental Haematology Unit, G.Gaslini Children's Hospital, Genova, Italy and SWG on Granulocytes and Monocytes of the EHA
| | - Helen A Papadaki
- Department of Hematology, University of Crete Medical School, Heraklion, Greece and SWG on Granulocytes and Monocytes of the EHA
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29
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Varadhi A, Hageman JR, Yu KOA. The 'five fingers' of the diagnostic evaluation for suspected immunodeficiency. Pediatr Ann 2013; 42:210-5. [PMID: 23641892 DOI: 10.3928/00904481-20130426-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ashvini Varadhi
- Department of Pediatrics, Comer Children’s Hospital, Pritzker School of Medicine, University of Chicago, Chicago, IL 60637, USA.
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