scholarly journals TROMBOCYTOSIS FOLLOWING SPLENECTOMY IN PEDIATRIC PATIENTS

2016 ◽  
Vol 65 (2) ◽  
pp. 166-169
Author(s):  
Andreea Ligia Dinca ◽  
◽  
Cristina Oana Marginean ◽  
Despina Baghiu ◽  
Alina Grama ◽  
...  
Keyword(s):  
Platelet Count ◽  
Retrospective Study ◽  
Pediatric Patients ◽  
Severe Form ◽  
Study Group ◽  
Inclusion Criteria ◽  
Mild Form ◽  
Reactive Thrombocytosis ◽  
Thrombotic Complications ◽  
Post Traumatic

Thrombocytosis represents a platelet count over 500.000/mm³. Objective. The aim of this study is to evaluate the frequency and gravity of reactive thrombocytosis in pediatric patients who underwent splenectomy. Material and method. We performed a retrospective study including 20 patients (4-16 years old) who underwent splenectomy between 2006-2015. The inclusion criteria in the study were: patients with the age under 18 years, who underwent splenectomy independently by the cause, and who developed afterwards thrombocytosis. Results. In the studied group 64% of the splenectomised patients (16) developed a form of thrombocytosis. In 4 cases – severe form (Platelets > 1 million/mm3) and in 7 cases a mild form. There were not noticed any significant differences regarding the gender repartition of the patients (9 were females, and 11 were males). In 13 patients, thrombocytosis disappeared after 30 days, and only in 3 cases, the episode lasted more than 360 days. Thrombotic phenomena were noticed only in one patient from our study group. All the patients benefited from thromboprophylaxis and hydration measures, and 2 cases needed associated treatment with Hydroxyurea. Conclusions. Our study reveals an increased frequency of thrombocytosis after splenectomy (80%), with a maximum peak of incidence in 2-10 days following the intervention, thrombocytosis being generally benign and self-limited; still one of the cases experienced thrombotic complications and severe thrombocytosis was more frequent after post-traumatic splenectomy.

A Large Proportion of Patients With a Diagnosis of Essential Thrombocythemia Do Not Have a Clonal Disorder and May Be at Lower Risk of Thrombotic Complications

Blood ◽  
1999 ◽  
Vol 93 (2) ◽  
pp. 417-424 ◽  
Author(s):  
Claire N. Harrison ◽  
Rosemary E. Gale ◽  
Samuel J. Machin ◽  
David C. Linch
Keyword(s):  
Bone Marrow ◽  
Platelet Count ◽  
Essential Thrombocythemia ◽  
Lower Risk ◽  
Study Group ◽  
Reactive Thrombocytosis ◽  
Age Related ◽  
Hemorrhagic Complications ◽  
Thrombotic Complications

Abstract Essential thrombocythemia (ET) is traditionally considered to be a clonal disorder. No specific karyotypic abnormalities have been described, but the demonstration of clonality using X-chromosome inactivation patterns (XCIPs) has been used to differentiate ET from a non-clonal reactive thrombocytosis. However, these assays may be difficult to interpret, and contradictory results have been reported. We have studied 46 females with a diagnosis of ET according to the Polycythemia Vera Study Group (PVSG) criteria. XCIP results in 23 patients (50%) were uninterpretable due to either constitutive or possible acquired age-related skewing. Monoclonal myelopoiesis could be definitively shown in only 10 patients. Thirteen patients had polyclonal myelopoiesis, and in 8, it was possible to exclude clonal restriction to the megakaryocytic lineage. Furthermore, there was no evidence of clonal progenitors in purified CD34+CD33− and CD34+CD33+ subpopulations from bone marrow of 2 of these 13 patients. There was no difference between patients with monoclonal and polyclonal myelopoiesis with respect to age or platelet count at diagnosis, duration of follow-up, incidence of hepatosplenomegaly, or hemorrhagic complications. However, polyclonal patients were less likely to have experienced thrombotic events (P = .039). These results suggest that ET is a heterogeneous disorder, and the clinical significance of clonality status warrants investigation in a larger study.

A Large Proportion of Patients With a Diagnosis of Essential Thrombocythemia Do Not Have a Clonal Disorder and May Be at Lower Risk of Thrombotic Complications

Blood ◽  
1999 ◽  
Vol 93 (2) ◽  
pp. 417-424 ◽  
Author(s):  
Claire N. Harrison ◽  
Rosemary E. Gale ◽  
Samuel J. Machin ◽  
David C. Linch
Keyword(s):  
Bone Marrow ◽  
Platelet Count ◽  
Essential Thrombocythemia ◽  
Lower Risk ◽  
Study Group ◽  
Reactive Thrombocytosis ◽  
Age Related ◽  
Hemorrhagic Complications ◽  
Thrombotic Complications

Essential thrombocythemia (ET) is traditionally considered to be a clonal disorder. No specific karyotypic abnormalities have been described, but the demonstration of clonality using X-chromosome inactivation patterns (XCIPs) has been used to differentiate ET from a non-clonal reactive thrombocytosis. However, these assays may be difficult to interpret, and contradictory results have been reported. We have studied 46 females with a diagnosis of ET according to the Polycythemia Vera Study Group (PVSG) criteria. XCIP results in 23 patients (50%) were uninterpretable due to either constitutive or possible acquired age-related skewing. Monoclonal myelopoiesis could be definitively shown in only 10 patients. Thirteen patients had polyclonal myelopoiesis, and in 8, it was possible to exclude clonal restriction to the megakaryocytic lineage. Furthermore, there was no evidence of clonal progenitors in purified CD34+CD33− and CD34+CD33+ subpopulations from bone marrow of 2 of these 13 patients. There was no difference between patients with monoclonal and polyclonal myelopoiesis with respect to age or platelet count at diagnosis, duration of follow-up, incidence of hepatosplenomegaly, or hemorrhagic complications. However, polyclonal patients were less likely to have experienced thrombotic events (P = .039). These results suggest that ET is a heterogeneous disorder, and the clinical significance of clonality status warrants investigation in a larger study.

Eltrombopag w leczeniu przewlekłej małopłytkowości immunologicznej u pacjentów pediatrycznych – doświadczenia ośrodka

2018 ◽  
Vol 22 (4) ◽  
Author(s):  
Katarzyna Koch ◽  
Paweł Łaguna ◽  
Anna Adamowicz-Salach ◽  
Marek Karwacki ◽  
Anna Klukowska ◽  
...  
Keyword(s):  
Platelet Count ◽  
Immune Thrombocytopenia ◽  
Pediatric Patients ◽  
Blood Platelets ◽  
Immunosuppressive Drugs ◽  
Study Group ◽  
Pediatric Hematology ◽  
Thrombopoietin Receptor ◽  
Study Evaluation ◽  
Medical University

Introduction. Immune thrombocytopenia (ITP) is an autoimmune disease that results in a reduction of blood platelets <100 X 109/l. Immune thrombocytopenia for over 12 months is defined as chronic ITP. The introduction of a drug program to chronic thrombocytopenia with the use of thrombopoietin receptor agonists (eltrombopag) is associated with high hopes of achieving lasting remission of the disease and increasing the chances of avoiding splenectomy. Aim of the study. Evaluation of the effectiveness of eltrombopag is increasing the platelet count in patients with cITP treated in the Department of Pediatric Hematology and Oncology of the Medical University of Warsaw. Materials and methods. The study group consisted of 6 patients (6 girls and 4 boys) aged 4 to 12 years, with cITP. The patients' qualification for the examination and further treatment were realized in accordance with the criteria of the B.98 drug program „Eltrombopag in the treatment of pediatric patients with cITP”. The first of the reported patients was treated with eltrombopag from September 2016 to December 2016, before the drug program was created. Results. All patients responded to eltrombopag treatment. One of the patients has already completed therapy and the remaining patients are still treated according to the B.98 drug program. Two patients receive eltrombopag in monotherapy, three patients require additional immunosuppressive drugs. During treatment, three patients experienced a decrease in the number of platelets requiring the use of immunoglobulin infusions or pulses from a methylprednisolone. During the therapy no hepatotoxicity or development of cataract was observed.

scholarly journals Our experience with progressive perineal urethroplasty and anastomotic urethroplasty in post-traumatic urethral strictures in pediatric patients

2017 ◽  
Vol 4 (2) ◽  
pp. 491
Author(s):  
Abhishek Jaysukh Savalia ◽  
Prakash W. Pawar ◽  
Ajit S. Sawant ◽  
Ashwin Tamhankar ◽  
Sunil R. Patil ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Urethral Stricture ◽  
Pelvic Fracture ◽  
Pediatric Patients ◽  
Maximum Velocity ◽  
Bulbar Urethra ◽  
Good Outcome ◽  
Urethral Strictures ◽  
Post Traumatic ◽  
Anastomotic Urethroplasty

Background: Confined perineum and elevated prostate and bladder in children make management of post-traumatic stricture in children technically difficult.Methods: A retrospective study of patients from 2007 till September 2016 was conducted. 15 pediatric patients with a mean age of 7.3 years presented with post traumatic urethral stricture or distraction defect. 11 patients had pelvic fracture urethral distraction defect (PFUDD) and underwent PPU. Four had bulbar stricture caused by straddle injury and underwent EEU. Post operatively patients were evaluated using uroflowmetry at 3, 6 and 12 months. Maximum velocity of less than 10 ml/s and symptoms of straining was considered as recurrence and such cases were evaluated further with MCU, RGU and cystoscopy.Results: Mean stricture length was of 2.3 cm and was at bulbo-membranous junction in 11 and in proximal bulbar urethra in 4. Of the 11 PPUs, crural separation was done in nine and inferior pubectomy in six patients. Transpubic approach was required in one patient. Gracilis flap was placed in one patient as an onlay over anastomotic urethroplasty. Of the 11 PPUs, 2 patients and 1 of 4 EEU patients had recurrence.  All recurrent strictures were <1.5 cm long and at the site of the anastomosis. Two patients were managed with anastomotic urethroplasty. The remaining one patient could be managed with laser visual internal urethrotomy.Conclusions: PPU and EEU are treatment of choice in paediatric patients with PFUDD and proximal bulbar strictures respectively. Both are technically feasible, have good outcome and have an acceptable morbidity.

scholarly journals Characterization of the Rate, Predictors, and Thrombotic Complications of Thrombocytosis in Iron Deficiency Anemia

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 959-959 ◽  
Author(s):  
Andrew B Song ◽  
David J. Kuter ◽  
Hanny Al-Samkari
Keyword(s):  
Platelet Count ◽  
Iron Deficiency ◽  
Multivariate Regression ◽  
Research Funding ◽  
Chart Review ◽  
Deficiency Anemia ◽  
Thrombotic Risk ◽  
Reactive Thrombocytosis ◽  
Thrombotic Complications ◽  
Platelet Mass

Introduction: Iron deficiency anemia (IDA) is the most common cause of anemia worldwide and is frequently untreated or undertreated (Kesselbaum et al. 2014). The association of thrombocytosis with IDA is well-recognized, with recent work elucidating its underlying physiology (Xavier-Ferrucio et al. 2018). Thrombocytosis in IDA may predispose to thrombotic complications, as described in many case reports. Given that IDA is ubiquitous, even minor increases in thrombotic risk due to thrombocytosis have dramatic public health implications. Data describing the rate, predictors, and risk of thrombotic complications are limited. This study characterizes these features of thrombocytosis in IDA. Methods: We queried a large institutional patient data repository containing comprehensive chart data for over 5.8 million patients to identify patients with IDA with and without thrombocytosis and thrombotic events over a 40-year time period (1979 to 2019). Demographic information, hematological parameters, thrombosis history, and other medical history were collected at time of peak thrombocytosis, time of IDA diagnosis, and clinical baseline (before IDA diagnosis or after resolution). The fidelity of query data was assessed by performing detailed manual chart review of 700 total patients. Clinical diagnoses of IDA were verified by confirming ferritin values &lt;30 ng/ml and consistent CBC parameters. Temporal association of thrombocytosis with IDA was confirmed and patients with other causes of thrombocytosis (including active malignancy, infection, inflammatory bowel disease, recent surgery/trauma, inflammatory arthritis, and myeloproliferative neoplasms) were excluded. Only arterial and venous thrombotic events occurring concurrently with IDA or IDA with thrombocytosis were included. Data were analyzed using t-tests, chi-square tests, Pearson correlations, and multivariate regression. Results: Our queries identified 36,327 IDA cases and 15,022 IDA with thrombocytosis cases. Query fidelity rates were 95% and 75%, respectively, yielding a true thrombocytosis rate of 32.6% in patients with IDA. After excluding cases with other causes of thrombocytosis, we calculated a 7.8% rate of thrombosis in patients with IDA and a 15.8% rate of thrombosis in patients with reactive thrombocytosis secondary to IDA (Table 1, Figure). The odds ratio for thrombosis in IDA with thrombocytosis vs IDA alone was 2.23 (2.09-2.38, p&lt;0.0001). Both venous and arterial thrombotic events were more likely in patients with IDA and thrombocytosis (Table 1). Risk factors for thrombotic events were slightly more common in patients with IDA and thrombosis (OR 1.28, Table 1). Mean duration of IDA episode (from IDA diagnosis to normalization of hemoglobin and platelet count) was 2.03 years. Among patients with IDA and thrombocytosis, ferritin and hemoglobin (Hgb) were both moderately negatively correlated with platelet count (Plt) (Table 2). Platelet mass index (Plt x MPV) at time of IDA diagnosis and peak thrombocytosis was significantly higher than baseline. Platelet mass index and Hgb were strongly negatively correlated at peak thrombocytosis. Multivariate regression including age, sex, WBC count, Hgb, Plt, and MCV demonstrated a significant predictive relation between decreasing Hgb and increasing Plt at peak thrombocytosis. Conclusions: In this large retrospective analysis, we describe the rate and predictors of thrombocytosis in IDA in addition to rates of thrombosis in IDA patients with and without reactive thrombocytosis. Combining queries of a massive clinical database with manual chart review to ensure data validity, we found a 32.6% rate of thrombocytosis in IDA, negative correlations between both Hgb/ferritin and Plt, and a 2-fold increased thrombotic risk in patients with thrombocytosis reactive to IDA relative to IDA alone. We also found increased total body platelet mass in IDA patients with thrombocytosis, which may contribute to this increased thrombotic risk. Thrombosis rates overall were high, possibly due to database inclusion of more morbid inpatients in addition to outpatients. Given the global burden of untreated and undertreated IDA, our findings suggest that adequate IDA treatment may reduce thrombotic complications and associated morbidity and mortality. Acknowledgements: A. Song is the recipient of the American Society of Hematology HONORS Award (provides research support). Disclosures Kuter: Daiichi Sankyo: Consultancy, Honoraria; Amgen: Consultancy, Honoraria, Research Funding; Merck Sharp Dohme: Consultancy, Honoraria; Up-to-Date: Consultancy, Honoraria, Patents & Royalties: 3 Up-to-Date chapters; Caremark: Consultancy, Honoraria; Bristol Myers Squibb (BMS): Consultancy, Honoraria, Research Funding; Platelet Disorder Support Association: Consultancy, Honoraria; Alnylam: Consultancy, Honoraria, Research Funding; Zafgen: Consultancy, Honoraria; UCB: Consultancy, Honoraria; Genzyme: Consultancy, Honoraria; Kezar: Research Funding; Principia: Consultancy, Honoraria, Research Funding; Shire: Consultancy, Honoraria; Takeda (Bioverativ): Consultancy, Honoraria, Research Funding; Kyowa-Kirin: Consultancy, Honoraria; Momenta: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria; Argenx: Consultancy, Honoraria, Research Funding; Agios: Consultancy, Honoraria, Research Funding; Actelion (Syntimmune): Consultancy, Honoraria, Research Funding; Dova: Consultancy, Honoraria; Protalix: Consultancy, Honoraria; Sanofi: Consultancy, Honoraria; Protalex: Consultancy, Honoraria, Research Funding; Shinogi: Consultancy, Honoraria; Rigel: Consultancy, Honoraria, Research Funding. Al-Samkari:Agios: Consultancy, Research Funding; Dova: Consultancy, Research Funding; Moderna: Consultancy.

scholarly journals Ectopic Eruption of the First Permanent Molar in the Maxilla: Cephalometric Features of 13 Pediatric Patients

2021 ◽  
Vol 11 (17) ◽  
pp. 7869
Author(s):  
Daniela Di Venere ◽  
Alessandra Laforgia ◽  
Paola Lorusso ◽  
Saverio Capodiferro ◽  
Massimo Corsalini
Keyword(s):  
Retrospective Study ◽  
Pediatric Patients ◽  
Group Differences ◽  
Control Group ◽  
Study Group ◽  
Mandibular Angle ◽  
Permanent Molar ◽  
Ectopic Eruption

Ectopic eruption of the first permanent molar in the maxilla, generally characterized by the wrong axial positioning during eruption, is reported to occur in about 2–6% of children. Its incidence is surely under-estimated as it frequently remains undiagnosed and, additionally, becomes irreversible, resulting in posterior crowding in such cases. This retrospective study aims to investigate the cephalometric features of patients affected by ectopic eruption of the maxillary first molar in comparison to a control group of patients. From a total of 1935 subjects, 13 patients were enrolled in the study group, while 26 patients were randomly selected as a control group. Lateral cephalometric teleradiographs obtained at the time of diagnosis were used to measure cephalometric values between study patients and controls. The prevalence of ectopic eruption of the first maxillary permanent molar in our patients was 1.14%. The mandibular angle (SN-GoMe) was found to be significantly greater in the study group than in control. The same statistical trend was observed for the inter-maxillary angle (SnaSnp-GoMe); also, the distance Sna-Me was greater in the study group. Differences between groups were statistically significant for the following distances: Snp-Sna, Ba-S and SOR-Sna, which were found to be, overall, greater in the study group. Ectopic eruption of the first permanent molar in the maxilla seems to be associated with morphogenetic characteristics of patients, mainly with a dolichocephalic pattern.

Skeletal and Dental Correction and Stability Following LeFort I Advancement in Patients With Cleft Lip and Palate With Mild, Moderate, and Severe Maxillary Hypoplasia

2021 ◽  
pp. 105566562199610
Author(s):  
Buddhathida Wangsrimongkol ◽  
Roberto L. Flores ◽  
David A. Staffenberg ◽  
Eduardo D. Rodriguez ◽  
Pradip. R. Shetye
Keyword(s):  
Retrospective Study ◽  
Outcome Measures ◽  
Cleft Lip ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Inclusion Criteria ◽  
Maxillary Hypoplasia ◽  
Main Outcome Measure ◽  
Lateral Cephalograms

Objective: This study evaluates skeletal and dental outcomes of LeFort I advancement surgery in patients with cleft lip and palate (CLP) with varying degrees of maxillary skeletal hypoplasia. Design: Retrospective study. Method: Lateral cephalograms were digitized at preoperative (T1), immediately postoperative (T2), and 1-year follow-up (T3) and compared to untreated unaffected controls. Based on the severity of cleft maxillary hypoplasia, the sample was divided into 3 groups using Wits analysis: mild: ≤0 to ≥−5 mm; moderate: <−5 to >−10 mm; and severe: ≤−10 mm. Participants: Fifty-one patients with nonsyndromic CLP with hypoplastic maxilla who met inclusion criteria. Intervention: LeFort I advancement. Main Outcome Measure: Skeletal and dental stability post-LeFort I surgery at a 1-year follow-up. Results: At T2, LeFort I surgery produced an average correction of maxillary hypoplasia by 6.4 ± 0.6, 8.1 ± 0.4, and 10.7 ± 0.8 mm in the mild, moderate, and severe groups, respectively. There was a mean relapse of 1 to 1.5 mm observed in all groups. At T3, no statistically significant differences were observed between the surgical groups and controls at angle Sella, Nasion, A point (SNA), A point, Nasion, B point (ANB), and overjet outcome measures. Conclusions: LeFort I advancement produces a stable correction in mild, moderate, and severe skeletal maxillary hypoplasia. Overcorrection is recommended in all patients with CLP to compensate for the expected postsurgical skeletal relapse.

scholarly journals Characteristics of Pediatric Emergency and Risk Factors for Life-saving Interventions

2021 ◽  
Vol 8 ◽  
pp. 2333794X2199034
Author(s):  
Phatthranit Phattharapornjaroen ◽  
Yuwares Sittichanbuncha ◽  
Pongsakorn Atiksawedparit ◽  
Kittisak Sawanyawisuth
Keyword(s):  
Risk Factors ◽  
Analytical Study ◽  
Pediatric Patients ◽  
Pediatric Emergency ◽  
Limited Data ◽  
Inclusion Criteria ◽  
Resuscitation Room ◽  
Life Saving ◽  
Level 1 ◽  
Triage Level

Pediatric emergency patients are vulnerable population and require special care or interventions. Nevertheless, there is limited data on the prevalence and risk factors for life-saving interventions. This study is a retrospective analytical study. The inclusion criteria were children aged 15 years or under who were triaged as level 1 or 2 and treated at the resuscitation room. Factors associated with LSI were executed by logistic regression analysis. During the study period, there were 22 759 ER visits by 14 066 pediatric patients. Of those, 346 patients (2.46%) met the study criteria. Triage level 1 accounted for 16.18% (56 patients) with 29 patients (8.38%) with LSI. Trauma was an independent factor for LSI with adjusted odds ratio (95% CI) of 4.37 (1.49, 12.76). In conclusion, approximately 8.38% of these patients required LSI. Trauma cause was an independent predictor for LSI.

scholarly journals Parasitic infections in Swiss children: Are we overtesting?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Corinne Légeret ◽  
Céline Rüttimann ◽  
Hans Fankhauser ◽  
Henrik Köhler
Keyword(s):  
Retrospective Study ◽  
Positive Result ◽  
Pediatric Patients ◽  
Intestinal Parasites ◽  
Gastrointestinal Symptoms ◽  
International Travel ◽  
Parasitic Infections ◽  
Stool Samples ◽  
Stool Specimens

Abstract Background A wide variation of causes can lead to gastrointestinal symptoms in children- an infection with parasites is one of them. The expansion of international travel might lead to an increase in testing children for a correspondent infection. Currently there are no guidelines available, which patients should be tested for a possible parasitical infection. The aim of the study was to characterize Swiss children suffering from intestinal parasites, in order to provide more knowledge for the clinician who should be tested. Methods This is a retrospective study of Swiss pediatric patients, whose stools have been tested for parasites and helminths. Results A total of 1855 stool samples, belonging to 572 different children with an average age of 7.9 years, were tested within a 10-year period. The prevalence of a positive result was 4.2%, of which all were positive for Blastocystis, and 12.5% had a co-infection with Endolimax nana. Conclusion Immigrants, immune compromised children with diarrhea and pediatric patients with bloody or protracted diarrhea should have 2 different stool specimens examined for a possible parasitical infection.

scholarly journals Radiological Parameters Review for Choanal Atresia

2021 ◽  
Vol 13 (2) ◽  
pp. 302-311
Author(s):  
Daniela Messineo ◽  
Maryia Chernikava ◽  
Valeria Pasquali ◽  
Serena Bertin ◽  
Mario Ciotti ◽  
...  
Keyword(s):  
Retrospective Study ◽  
High Resolution ◽  
Surgical Approach ◽  
Choanal Atresia ◽  
Point Of View ◽  
Control Group ◽  
Study Group ◽  
Control Groups ◽  
Imaging Parameters ◽  
Multiplanar Imaging

(1) Background: The study aims to identify which imaging parameters are necessary for a new correct surgical approach in the study of choanal atresia, and which anatomical findings are essential for correct planning of endoscopic treatment in choanal atresia. (2) Methods: In this retrospective study, 19 patients with choanal atresia had high-resolution multiplanar imaging (14 cases aged ≤1 year and 5 cases aged 1 to 3 years) and 35 patients in the control group similarly distributed by age. Fourteen variables, the most relevant from a surgical point of view, were selected and measured. A comparison was made between the averages of the study group and the different control groups, either directly observed or selected from the literature, using Pearson’s correlation. (3) Results: In 14 out of 26 cases, the differences were statistically significant. There was a correlation between the structures assessed, such as choanal height, rostrum height, and age. (4) Conclusions: Thanks to volumetric reformatting, this work identified and provided the clinician with useful information that helped choose the correct surgical approach. Furthermore, it focused on which imaging parameters are necessary to improve the planning of the surgical correction of choanal atresia.

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