Renal Doppler Sonography As A Non-Invasive Technique For Early Detection Of Sickle Nephropathy In Children.. [DOI: 10.21203/rs.3.rs-2902442/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Objective: Early identification of sickle nephropathy via renal doppler sonography among sickle cell disease patients so as to help in early diagnosis and interventions to prevent progression to end-stage renal disease. Methods: 45 SCD children were included along with 45 healthy control children. Renal doppler sonography (PI and RI) was performed to all subjects. Doppler indices (Resistance Index and pulsatility index) were of value to assess reno-vascular changes in SCD. Laboratory investigations were done: Hb electrophoresis, complete blood picture with blood indices, reticulocytic count, liver enzymes (ALT and AST), HCV serology, serum ferritin and lactate dehydrogenese (LDH). Results: The study group consisted of 45 SCD patients, 27 (60%) males with mean age 12 years (± 3 years). By performing renal doppler sonography, it was found that all study group had significantly higher doppler indices (Resistivity index and pulsatility index) compared to the control group. Results of renal doppler sonography revealed, Main renal pulsatility index was positively correlated with main renal resistance index (r=0.454, p=0.002). Conclusion: Roc curve showed that Main Renal Artery Pulsatility index and resistance index index could act as a predictor for sickle cell nephropathy with high sensitivity values. Otherwise, renal doppler indices didn’t show statistically significant correlation with the other studied variables.

Three siblings with variable degrees of neuromuscular involvement and congenital sideroblastic anemia: A peculiar phenotype and a surprise genotypic explanation

INTRODUCTION

Congenital sideroblastic anemias (CSAs) are a group of inherited bone-marrow disorders manifesting with erythroid hyperplasia and ineffective erythropoiesis.

METHODS

We describe a detailed clinical and genetic characterization of three siblings with CSA.

RESULTS

Two of them had limb-girdle myopathy and global developmental delay. The two elder siblings performed allogenic hematopoietic stem-cell transplantation 5 and 3 years prior with stabilization of the hematological features. Exome sequencing in the non-transplanted sibling revealed a novel homozygous nonsense variant in SLC25A38 gene NM_017875.2:c.559C > T; p.(Arg187*) causing autosomal-recessive sideroblastic anemia type-2, and a second homozygous pathogenic previously reported variant in GMPPB gene NM_013334.3:c.458C > T; p.(Thr153Ile) causing autosomal-recessive muscular dystrophy-dystroglycanopathy type B14. With the established diagnosis, hematopoietic stem cell transplantation is now being scheduled for the youngest sibling, and a trial therapy with acetylcholine esterase inhibitors was started for the two neurologically affected patients with partial clinical improvement.

CONCLUSION

This family emphasizes the importance of whole-exome sequencing for familial cases with complex phenotypes and vague neurological manifestations.

Reticulocyte hemoglobin content: a simple parameter for detection of iron deficiency anemia in children with chronic liver disease

Background

Iron deficiency anemia is common among patients with chronic liver disease. Reticulocyte hemoglobin is a marker for iron availability in the bone marrow that is not affected by inflammation.

Objective

The aim of this study is to detect the diagnostic value of reticulocyte hemoglobin (Ret-Hb) in diagnosis of iron deficiency anemia among children with chronic liver disease.

Methods

This is a cross-sectional study that included thirty-three children with chronic liver disease (CLD) and Hb < 11 g/dL, MCV < 77 fl, regularly attending the Pediatric Hepatology Clinic, Cairo University Children Hospitals. Patients underwent full history taking, and full iron profile and reticulocyte Hb were done.

Results

The median age of our patients was 5.9 years with a median age of onset of CLD was 1.6 years. The mean reticulocytic Hb was 25.52 ± 4.53 pg (N: 28–36 pg). Mean serum ferritin was 89 ± 16.55 ng/ml (N: 7–140 ng/ml). There was a statistically positive significant linear correlation between S-ferritin and Ret. Hb, r = +0.433, p = 0.012. ROC curve analysis of reticulocytic Hb, at cutoff ≤ 29.3 pg for diagnosis of iron deficiency anemia in children with CLD, had an AUC of 0.824 with a sensitivity of 92.59% and a specificity of 83.33%, with p = 0.012.

Conclusion

Reticulocyte Hb is a sensitive and specific marker for detection of iron deficiency anemia in CLD patients. Anemia in CLD was mostly iron deficiency anemia.

Low absolute neutrophilic and lymphocytic counts in children with CMV reactivation following HSCT

Introduction: Cytomegalovirus (CMV) infection is one of the commonest infections after hemopoietic stem cell transplantation (HSCT) and it may lead to significant morbidity, mortality and can lead increased healthcare costs. Aim: The aim of this work was to evaluate the relation between neutrophilic and lymphocytic count recovery in children with CMV reactivation following HSCT. Method: The study included 30 patients with CMV reactivation who underwent allogenic hematopoietic stem cell transplantation for non-malignant diseases in Abo El-Reesh Al Mounira Pediatric Hospital, Cairo University. Pre- and post-transplant clinical and laboratory data were collected. Results: The 30 patients developed 69 episodes of CMV reactivation. 66.6% and 53.5% of the reactivation episodes were associated with low absolute lymphopenic and neutrophilic respectively. The early CMV reactivation episodes were associated with severe low absolute lymphocytic and neutrophilic counts with p value (0.003, 0.006) respectively. Conclusion: Neutrophilic and lymphocytic count recovery is an important factor associated with reactivation. Importance of close monitoring of viral load among lymphopenic and neutropenic patients for strong surveillance and early detection of CMV reactivation and proper management.