A study of hematological parameters and requirement of platelet transfusion in dengue fever

Background: Dengue is a common vector-borne disease in India with significant morbidity & mortality. Thrombocytopenia is a common complication in dengue. Bleeding manifestations in dengue put an immense pressure on both patients and treating physicians. There are no clear guidelines for transfusion of platelets in bleeding patients and role of Platelet transfusion in this condition is a bit controversial.Methods: It was an observational study done at Sree Rajarajeswari medical college and hospital between 1st May and 31st July 2016. Total of 100 dengue-positive cases were studied with respect to clinical features, laboratory parameters and requirement of platelet transfusion.Results: Majority of patients were males and in the age group 21-30 years. Fever was present in all cases, with a mean of 3-6 days duration. Epistaxis was the most common bleeding manifestation (43%), Malena being the least (3%). Leucopenia was observed in 52% patients. Thrombocytopenia was seen in 89% of admitted patients and 38% among them had raised aPTT. 53%of patients in our study received platelet transfusion.Conclusions: Bleeding manifestations have no significant association with severity of platelet count. Severe leucopenia is associated with thrombocytopenia. There is no need of platelet-transfusion in all patients with thrombocytopenia with minor bleeds.

Approach on risk factors of bovine trypanosomosis due to Trypanosoma vivax in the Bolivian and Brazilian pantanals

Trypanosoma vivax caused between 1995 and 1997 a devastating disease in Bolivian andBrazilian Pantanals. These regions are very important beef cattle breeding in Brazil andBolivia. The principal clinical signs of bovine trypanosomosis in livestock were anemia,severe leucopenia, and abortion. The purpose of the present study was to analyze the riskfactors of the natural bovine trypanosomosis in the Bolivian and Brazilian Pantanals. Weconcluded that the principal risk factors related to T. vivax transmission in the Bolivian andBrazilian Pantanals were the transportation by foot, because the conditions for acquisition ortransmission of T. vivax were greatest at the numerous resting places along the route, the useof contaminated needles during vaccinations, and transmission by tabanids during the rainyseason. The fauna contamination should be also considered.

Leucopenia during Treatment Is a Good Prognostic Risk Factor for Patients Undergoing Chemotherapy for Hodgkin’s Lymphoma: An Analysis of the German Hodgkin Study Group (GHSG).

Purpose: A systematic analysis of gender-specific factors in Hodgkin’s lymphoma (HL) studies previously revealed a better outcome for female HL patients. Factors contributing to better prognosis among female patients not only included more favorable risk factors at diagnosis, but also more treatment-induced severe leuopenia (WHO grade III/IV). The purpose of the current analysis was to characterize and investigate the protective role of severe leucopenia for both, male and female HL patients. Patients and Methods: 4626 HL patients including 2050 females (f) and 2576 males (m) of all prognostic risk groups who were enrolled into the multicenter studies HD4-HD9 of the GHSG were evaluated. The median follow-up after treatment was 5.5 years. Results: Female patients had a significantly better freedom from treatment failure (FFTF) with 81% at 66 months (95% confidence interval 79% – 82%), when compared with male patients (74%; 72% – 76%; p<.0001). This was in part related to the occurrence of more acute chemotherapy-related leucopenia (WHO grade III/IV): 69.9% in female patients and 55.2% in male patients (p<.0001). Furthermore, severe leucopenia during chemotherapy was strongly associated with better FFTF for both, male and female patients. Separate multivariate analyses showed that severe leucopenia remained significant when only male patients were included (0.011). In addition, patients who developed severe leucopenia within the first two cycles of chemotherapy also had a significantly better FFTF (p=.0002) compared with all other patients (Klimm et al, JCO in press). When considering patients with advanced HL undergoing BEACOPP in baseline or escalated dose, the presence of severe leucopenia during chemotherapy (p=.0074) was associated with a better outcome. This finding was also confirmed when only the first two cycles of treatment were analyzed (p =.0205). Conclusion: The protective role of severe leucopenia suggests evaluating of a more individualized therapy in future trials, that may be tailored in a response-adapted manner depending on the individual toxicity profile within the first cycles.

Role of Hematotoxicity and Sex in Patients With Hodgkin's Lymphoma: An Analysis From the German Hodgkin Study Group

Purpose Several scores have described sex as a prognostic factor in patients with Hodgkin's lymphoma (HL). However, little is known how sex-specific factors influence treatment outcome. We systematically investigated sex differences with regard to pretreatment characteristics and therapy-related variables, and examined their influence on the outcome of HL patients. Patients and Methods This analysis comprises 4,626 HL patients of all prognostic risk groups who were enrolled onto the multicenter studies HD4 to HD9 of the German Hodgkin Study Group. At 5.5 years, 2,050 female and 2,576 male patients were analyzed. Results Male and female patients had similar prognostic factors. There was more acute chemotherapy-related hematotoxicity in women, especially more severe leucopenia (WHO grade 3/4, 69.9% female and 55.2% male; P < .0001). Importantly, this did not translate into more infections. Female patients had similar response rates but fewer relapses and deaths, leading to a significantly better freedom from treatment failure (FFTF; at 66 months, 81% female [95% CI, 79% to 82%] and 74% male [95% CI, 72% to 76%]). Severe leucopenia during chemotherapy was strongly associated with better FFTF, both for males and females. In addition, when only those patients who developed severe leucopenia within the first two cycles of chemotherapy were included, the factor maintained its protective role. Conclusion The protective role of severe leucopenia suggests the testing of a more individualized therapy. In future trials, this therapy may be tailored in a response-adapted manner depending on the individual toxicity profile within the first cycles.

The Superior Prognosis of Female Patients with Hodgkin’s Lymphoma Is Related to More Treatment-Induced Leucopenia and Warrants a More Individualized Therapy.

Purpose: Several scores have described gender as an important prognostic factor in patients with Hodgkin’s lymphoma (HL), particularly in advanced-stages. However, so far there is no larger analysis to systematically evaluate possible gender-specific factors. The purpose of this analysis was to investigate sex differences with regard to pre-treatment and therapy-related variables and to evaluate their influence on the outcome of HL patients. Patients and Methods: From 1988 to 1998 the GSHG conducted two generations of clinical trials for early, intermediate and advanced HL (HD4 - HD9). The present analysis comprises 4626 patients of all stages, aged 15 to 75 years, who were enrolled into these multicenter studies and treated according to the GHSG-study protocols. Results: At a median observation time of 5.5 years, 2050 female and 2576 male patients were suitable for this retrospective analysis. Patients in each group had very similar profiles in terms of age, performance status, stage, histological subtype, clinical risk factors and prognostic factors. Slightly more nodular sclerosis subtypes and mediastinal masses were observed in women. In contrast, more men had a mixed cellularity subtype, older age, advanced stage of disease, and B-symptoms at diagnosis. Acute chemotherapy-related toxicity was distributed almost equally. However, there was more hematotoxicity in females. This difference was most obvious for leucopenia [WHO grade III/IV: 69.9 % versus 55.2 %]. Importantly, there was no higher risk of infections in female patients. Response rates being similar in both groups, however, a lower rate of relapse and death was observed in females. Univariate analyses revealed significant better outcome in terms of FFTF and OS for females. In multivariate analyses, sex was not identified as an independent prognostic factor, however, lower stages of disease (p&lt;.0001), less B-symptoms (p&lt;.0001), younger age (p&lt;.0001), and leucopenia grade III/IV (p&lt;.0001) were significant variables to which better outcome in females can be related. Particularly, the high prevalence of leucopenia grade III/IV during chemotherapy has a clear impact on better FFTF in females. The smaller proportion of males expressing severe leucopenia also had better outcomes. In addition, when only those patients were included who developed leucopenia grade III/IV within the first two cycles of chemotherapy, the factor maintains its protective role. Conclusion: In this large retrospective analysis of the GHSG database, a better outcome is observed for female patients compared to male patients with HL. The protective role of severe leucopenia supports the rationale for a more individualized therapy, that may be tailored in a response-adapted manner depending on the individual toxicity profile within the first cycles.