An Unusual Case of Reactive Lymphocytosis Mimicking Acute Leukemia

The diagnosis of acute leukemia is based on a combination of clinical, hematological, morphological, cytogenetic, and immunophenotypic data. The authors report a case of reactive lymphocytosis with extremely elevated lymphocytic and lymphoblastic leukocytosis that mimicked acute lymphoblastic leukemia, not only morphologically, but also in immunophenotypic analysis. They could not determine any underlying disease marker other than infectious symptoms that were present for 20 days prior to presentation to their clinic. Although this case presented with extremely high lymphocytic leukocytosis, the patient had normal blood cell lineage, a moderate level of blastic cells in bone marrow, and normal physical findings. These findings convinced the authors to follow up the patient before beginning treatment.Wo

An Automated Image Analysis System Can be Beneficial in Preclassification of Leucocytes in Children with Hematological Disease.

This study was aimed to evaluate the analytical performance of an automated image analysis system (a pilot model of Diff Master™ Octavia) for the preclassification of leucocytes in children with hematological disease. Manual microscopy performed by pediatric hematologists was used as the reference method. Five mature cell class and blasts were evaluated. Diff Master Octavia correctly preclassified 87.4% of all leucocytes with a high reproducibility. The overall accuracy was found to be 93.0%. Clinical sensitivity was 97.7% and specificity was 76.0%. The average time per slide for Diff Master™ Octavia was 2.3 min lower than that of manual method. Our results indicated that the Diff Master™ Octavia can detect and preclassify leucocytes accurately; therefore, it can be used as an efficient and fast method in pediatric hematology routine. J. Clin. Lab. Anal. 25:71–75, 2011. © 2011 Wiley‐Liss, Inc.Wo

A Prompt Graft-Versus-Thalassemia Effect upon Withdrawal of CyclosporineA in A Child Who Received Allogeneic Peripheral Blood Stem Cell Transplantation

Stable mixed chimerism is a common event in children with thalassemia major who have undergone bone marrow transplantation (BMT). However, persistence of unstable mixed chimerism in these children is associated with a greater risk of rejection and/or relapse of the disease. Andreani et al.1 has reported that rejection and/or disease recurrence occurs in approximately one third of patients with early mixed chimerism in thalassemia major.Wo

Hepatitis B Immunoglobulin in Combination with Lamivudine for Prevention of Hepatitis B Virus Reactivation in Children Undergoing Bone Marrow Transplantation

Abstract: There is little information in literature about the use of hepatitis B immunoglobulin (HBIg) in recipients of bone marrow transplantation (BMT). Here, we report two children who received IV HBIg (Hepatect‐CP) and lamivudine treatment during BMT course for either patient or donor hepatitis B virus (HBV) viremia. A four‐year‐old girl underwent a fully human leukocyte antigen‐matched allogeneic BMT for thalassemia major from her mother positive for hepatitis B surface antigen (HBsAg). A 12‐yr‐old boy with chronic myeloid leukemia, positive for HBsAg and HBV‐DNA received a fully HLA‐matched allogeneic BMT from his sister in the first chronic phase of the disease. HBIg was successfully used in both cases to prevent HBV reactivation of the recipients. The results of our observations are encouraging and we suggest that HBIg in combination with lamivudine may be used in such cases especially in post‐transplant early period to prevent HBV reactivation.Wo

Pulmonary thromboembolism in childhood: a single-center experience from Turkey.

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Venous Thromboembolism after Allogeneic Pediatric Hematopoietic Stem Cell Transplantation: A Single-Center Study

Objective: Venous thromboembolism (VTE) in children who undergo hematopoietic stem cell transplantation (HSCT) has high morbidity. The aim of this study is to assess the incidence of VTE in allogeneic pediatric HSCT recipients and the contribution of pretransplant prothrombotic risk factors to thrombosis. Materials and Methods: We retrospectively evaluated 92 patients between April 2010 and November 2012 undergoing allogeneic HSCT who had completed 100 days post-HSCT. Before HSCT, coagulation profiles; acquired and inherited prothrombotic risk factors including FV G1691A (factor V Leiden), prothrombin G20210A, methylenetetrahydrofolate reductase (MTHFR) C677T, and MTHFR A1298C mutations; and serum homocysteine and lipoprotein (a), plasma antithrombin III, protein C, and protein S levels were obtained from all patients. Results: In the screening of thrombophilia, 8 patients (9%) were heterozygous for factor V Leiden, 5 (6%) were homozygous for MTHFR 677TT, 12 (14%) were homozygous for MTHFR 1298CC, and 2 (2%) were heterozygous for prothrombin G20210A mutation. We observed VTE in 5 patients (5.4%); a prothrombotic risk factor was found in 3 out of these 5 patients, while 4 out of 5 patients had central venous catheters. It was determined there was no significant relationship between VTE and inherited prothrombotic risk factors. Conclusion: VTE after HSCT seems to be a low-frequency event that may be due to low-dose, low-molecular-weight heparin prophylaxis, and the role of inherited prothrombotic risk factors cannot be entirely excluded without a prospective study

Severe Clinical Course in a Patient with Congenital Amegakaryocytic Thrombocytopenia Due to a Missense Mutation of the c-MPL Gene

Congenital amegakaryocytic thrombocytopenia (CAMT) generally begins at birth with severe thrombocytopenia and progresses to pancytopenia. It is caused by mutations in the thrombopoietin receptor gene, the myeloproliferative leukemia virus oncogene (c-MPL). The association between CAMT and c-MPL mutation type has been reported in the literature. Patients with CAMT have been categorized according to their clinical symptoms caused by different mutations. Missense mutations of c-MPL have been classified as type II and these patients have delayed onset of bone marrow failure compared to type I patients. Here we present a girl with severe clinical course of CAMT II having a missense mutation in exon 4 of the c-MPL gene who was admitted to our hospital with intracranial hemorrhage during the newborn period

Evaluation of Endocrine Late Complications in Childhood Acute Lymphoblastic Leukemia Survivors: A Report of a Single-Center Experience and Review of the Literature

Objective: Improvement in long-term survival in patients with acute lymphoblastic leukemia (ALL) in childhood has led to the need for monitorization of treatment-related morbidity and mortality. In the current study, we aimed to evaluate endocrine side effects of treatment in ALL survivors who were in remission for at least 2 years. Materials and Methods: Sixty patients diagnosed with ALL, who were in remission for at least 2 years, were cross-sectionally evaluated for long-term endocrine complications. Results: The median age of the patients at the time of diagnosis, at the time of chemotherapy completion, and at the time of the study was 5 years (minimum-maximum: 1.7-13), 8 years (minimummaximum: 4.25-16), and 11.7 years (minimum-maximum: 7-22), respectively, and median follow-up time was 4 years (minimummaximum: 2-10.1). At least one complication was observed in 81.6% of patients. Vitamin D insufficiency/deficiency (46.6%), overweight/ obesity (33.3%), and dyslipidemia (23.3%) were the three most frequent endocrine complications. Other complications seen in our patients were hyperparathyroidism secondary to vitamin D deficiency (15%), insulin resistance (11.7%), hypertension (8.3%), short stature (6.7%), thyroid function abnormality (5%), precocious puberty (3.3%), and decreased bone mineral density (1.7%). There were no statistically significant correlations between endocrine complications and age, sex, and radiotherapy, except vitamin D insufficiency/deficiency, which was significantly more frequent in pubertal ALL survivors compared to prepubertal ALL survivors (57.5% and 25%, respectively, p=0.011). Conclusion: A high frequency of endocrine complications was observed in the current study. The high frequency of late effects necessitates long-term surveillance of this population to better understand the incidence of late-occurring events and the defining of high-risk features that can facilitate developing intervention strategies for early detection and prevention

Nontypeable Haemophilus influenzae Otitis Media: Mastoiditis and Meningitis Complicated with Central Venous Thrombosis in an Immunocompetent Child

Implementation of the Haemophilus influenzae type B (Hib) conjugate vaccine brought about a reduction in the number of cases and morbidity from type B but an increase in nontypeable strain infections. Nontypeable Haemophilus influenzae (NTHi) commonly colonizes children’s upper respiratory tract and causes otitis media, sinusitis, and bronchitis. Invasive NTHi diseases, such as meningitis and septicemia, have rarely been reported. Herein, we discuss a previously healthy, fully immunized 3-year-old girl presented with otitis media and mastoiditis leading to meningitis caused by NTHi complicated with central venous thrombosis. She was treated with antibiotics, mastoidectomy and ventilation tube insertion, and anticoagulation therapy and recovered uneventfully. Through this case, we wish to share our unique clinical experience that NTHi should be born in mind as a potential pathogen that can cause meningitis in previously healthy children, which may be helpful in future cases