Clinical characteristics of hemophagocytic lymphohistiocytosis

BACKGROUND

There is no specificity in the clinical presentation of hemophagocytic lymphohistiocytosis (HLH).

OBJECTIVE

To study some clinical, etiological, and prognostic features of HLH to improve the clinical understanding of the disease.

METHODS

Retrospective analysis of the clinical data of 125 patients with HLH admitted to our hospital from June 2015 to August 2021, including clinical characteristics, laboratory indicators, and survival period. Statistical analysis was performed from the overall group of study indicators, which included population, children, and adults.

RESULTS

In the whole population, sex, age, blood myoglobin, and NK cell ratio of M-HLH and non-M-HLH patients (P< 0.05), serum albumin, and direct bilirubin were independent correlates of M-HLH. In the pediatric group, age and the proportion of NK cells were significantly different between M-HLH and non-M-HLH patients (P< 0.05). Multivariate Logistic regression analysis showed that all factors were not significantly associated with M-HLH. The associated regression analysis showed that all factors were not significantly associated with M-HLH. ROC curve analysis showed that the best predictive value of NK cell percentage for M-HLH diagnosis in the overall population was 4.96% in the pediatric group and 4.96% in the adult group. The best predictive value for M-HLH diagnosis was 2.08%. The univariate analysis showed that platelet count, alanine aminotransferase, aspartate aminotransferase, serum albumin, direct bilirubin and indirect bilirubin affected prognosis; COX regression showed that none of these factors had a significant relationship. The overall median survival time was 20.7 months in the adult group, 44.3 months in non-M-HLH patients, and 7.73 months in M-HLH patients (p= 0.011); univariate analysis showed that platelet count and serum albumin level affected prognosis; COX regression results in serum albumin level was an independent risk factor for prognosis.

CONCLUSION

The survival rate of non-M-HLH was significantly better than that of M-HLH; the proportion of NK cells had predictive value for the diagnosis of M-HLH; in the general population, non-M-HLH was more likely to have abnormal liver function than M-HLH: lower platelet count and serum albumin level were associated with poor prognosis, and the lower the platelet count and serum albumin level, the worse the prognosis: in addition, adults with lower serum albumin levels are also associated with poor prognosis.

Study on diagnostic value of results of EB virus nucleic acid quantification in whole blood lymphocyte and serum in children with EB virus infection

BACKGROUND

The article aims to study the results of EB virus nucleic acid quantification (EBV-DNA) in whole blood lymphocytes to examine whether serum can diagnose EB virus infection in children. Group A consisted of 65 children admitted to the hospital with a probable EB virus infection between February 2017 and February 2018. In the same period of health check-ups, 65 children were randomly selected as Group B.

METHODS

To find out the differences between Group A and Group B, EBV-DNAs in whole blood lymphocyte and serum were detected by quantitative fluorescence assay, and EBV-CA-IgM antibody was detected by enzyme-linked immunosorbent assay.

RESULTS

The results demonstrate that Group A had a greater rate of positive EBV-DNAs in whole blood lymphocytes and serum than Group B. EBV-DNA positivity was greater in whole blood lymphocytes of Group A and Group B than in serum. In whole blood lymphocytes from Group A, the positive rate of EBV-DNA and EBV-CA-IgM antibodies was statistically significant.

CONCLUSION

The positive rate of EBV-DNA in whole blood lymphocytes of EBV-infected children is higher than in serum, the suitable specimens for diagnosis should be chosen based on the individual condition of children patients.

Toxic epidermal necrolysis in a child 6 months post-hematopoietic stem cell transplantation

TEN is a rare and critical disease mostly caused by drugs. It is mediated by activated CD8+ T cells that cause keratinocyte apoptosis with the assistance of cytokines/chemokines. We herein report a pediatric case of TEN after allogeneic HSCT with precursor B-cell acute lymphoblastic leukemia (pre-B-ALL) in second complete remission. Although we did not evaluate the T-cell subpopulation in blood or skin lesion of the patient, an imbalanced immune reconstitution after HSCT might additively contribute to the development of TEN.