Use of granulocyte transfusion in early period in life-threatening infections of pediatric hematology and oncology patients: A single-center experience

Despite all the developments in medicine, infections continue to be one of the most important causes of mortality in pediatric hematology and oncology patients. The more severe the degree of neutropenia develops after intensive chemotherapy in cancer patients, and the longer the neutropenia duration, the higher the risk of infection. Granulocyte transfusion (GT) is used as supportive therapy in cases where the bone marrow needs time to recover in invasive bacterial or fungal infections along with severe neutropenia. The patients who had granulocyte transfusions in our clinic between June 2019 and June 2020 were reviewed retrospectively. A total of 15 units of granulocyte concentrate were used in 11 febrile neutropenia attacks of 9 patients. The demographic characteristics of the patients and features belonging to the period of GT were recorded. In our study, the clinical response rate after GT was 90.9 %, while the hematological response rate was 40 %. Most of the patients were treated succesfully, the mortality rate was 9%. We think that the most critical factor for success with GTs is determining the neutropenic patient in particular with a combination of high-risk malignancy and acute life-threatening infection for using GT. Also, early use of GT in those patients who do not recover despite appropriate antimicrobial and supportive treatment may contribute to improvement of the clinical conditon in a shorter period of time and reduction of repeated GTs

Predictive Factors for Response to a Standard Dose of Intravenous Immunoglobulin Therapy in Children with Immune Thrombocytopenia

Objective: Acute immune thrombocytopenic purpura (ITP) is a common acquired bleeding disorder. Intravenous immunoglobulin (IVIG) therapy is commonly given as initial treatment to pediatric patients with ITP. Factors that can predict the response to IVIG have not been fully determined. We retrospectively evaluated whether the clinical and laboratory findings of pediatric patients with ITP at the time of diagnosis could predict the response to IVIG and progression to chronic ITP. Methods: A total of 45 patients with newly diagnosed ITP who were initially treated with IVIG were evaluated between January 2016 and December 2019. Short-term response was estimated by platelet counts 2 weeks after IVIG, and long- term response was assessed by thrombocytopenia-free survival (TFS). TFS was defined as the probability of survival without treatment failure after initial IVIG, such as relapse, requiring additional therapeutic interventions, or progression to chronic ITP. Results: In univariate analysis, age ≥25 months (p=0.002), platelet count ≤6.9x109 /L (p=0.034), and hemoglobin (Hb) level >12.4 g/dl (p=0.001) were considered to be unfavourable factors for short-term response. Univariate analysis of unfavourable factors for longterm response showed that age ≥25 months (p=0.002), platelet count ≤6.9x109 /L (p=0.034), and Hb level >12.4 g/dl (p=0.001) were significant factors. Conclusion: These results suggest that in newly diagnosed ITP patients older than 25 months and/or with platelet count <6.9x109 /L, other therapeutic options such as corticosteroids alone or in combination with IVIG may be considered as initial therap