1/6. pulmonary alveolar proteinosis: a complication in patients with hematologic malignancy.We present the case of a patient with acute myeloid leukemia and secondary pulmonary alveolar proteinosis (PAP), which is an underestimated cause of a persistent pulmonary infiltrate in patients with hematologic malignancies often accompanied by neutropenia due to therapy. diagnosis is established by performing periodic acid-schiff reaction (PAS) stains and transmission electron microscopy (EM) on bronchoalveolar lavage (BAL) fluid. We wish to stress the importance of the early recognition of PAP, which is potentially reversible, and routinely performing PAS staining on BAL fluid in patients with a hematologic disease especially myeloid disorders and a persistent lung infiltrate.- - - - - - - - - - ranking = 1keywords = neutropenia (Clic here for more details about this article) |
2/6. Disseminated infection by scedosporium prolificans: an emerging fatality among haematology patients. Case report and review.We describe a case of proven disseminated infection by scedosporium prolificans in a profoundly neutropenic patient. The patient presented with a fever unresponsive to broad-spectrum antibiotics, endophthalmitis, respiratory failure and a renal abscess. The organism was isolated from bronchoalveolar lavage fluid and from pus obtained through a sterile puncture. review of the English-language literature identified 28 additional cases; these occurred exclusively in severely neutropenic patients (predominantly leukaemia) and in transplant recipients. Apart from two or possibly three cases, dissemination was uniformly fatal due to persistent neutropenia and inherited resistance of these pathogens to currently available antifungal drugs. At present, the optimal treatment of S. prolificans infections is unknown, but reversal of the underlying deficient immune status appears of great importance.- - - - - - - - - - ranking = 1keywords = neutropenia (Clic here for more details about this article) |
3/6. ehrlichiosis infection in a 5-year-old boy with neutropenia, anemia, thrombocytopenia, and hepatosplenomegaly.ehrlichiosis should be considered in the differential diagnosis of any patient with recent fever, pancytopenia, hepatosplenomegaly, and history of tick exposure. We present a previously healthy 5-year-old boy who was referred to the hematology-Oncology Clinic to consider a bone marrow etiologic process after his pediatrician discovered progressive neutropenia, anemia, thrombocytopenia, and hepatosplenomegaly accompanied by 2 days of fever. bone marrow aspirate and biopsy were nonrevealing. Because of the history of a recent tick bite, a diagnosis of ehrlichiosis infection was considered and ultimately confirmed by IgG-specific serum testing. The patient's fever was treated symptomatically with acetaminophen, and symptoms resolved on their own without intervention. ehrlichiosis is a tick-borne infection that occurs throughout the spring and summer, often causing findings that mimic a malignancy or serious hematologic disorder. The diagnosis should be considered in any person living in tick-infested areas and can be confirmed by polymerase chain reaction or serum antibody titers. Treatment with doxycycline can lead to rapid clinical improvement if the diagnosis is made early.- - - - - - - - - - ranking = 5keywords = neutropenia (Clic here for more details about this article) |
4/6. Efficacy and safety of G-CSF mobilized granulocyte transfusions in four neutropenic children with sepsis and invasive fungal infection.BACKGROUND: Bacterial and fungal infections are serious complications of cancer therapy. Especially during longstanding neutropenia, patients are at risk for life-threatening infections. The aim of this study was to assess the effect and safety of G-CSF mobilized granulocyte transfusions (GTX) in four neutropenic pediatric patients with sepsis. patients AND methods: The patients were between 4.6-17.5 years old and their diagnoses included very severe aplastic anemia, non-Hodgkin's lymphoma (NHL) and acute myeloid leukemia. Before GTX, all patients had fever despite antibiotic and antimycotic therapy, neutropenia (absolute neutrophil count ANC < 500/microl), increasing c-reactive protein (CRP) values, hypotension requiring dopamine infusion and three patients needed supplemental oxygen. The granulocyte donors received G-CSF (Neupogen, 5 microg/kg body weight) 12 h prior to granulocyte apheresis. RESULTS: In total, 40 GTX were performed (range 2-28 per patient). The mean increase of the granulocyte count 1 h after GTX was 1,310/microl (range 200-2,950/microl). Within the period of GTX the CRP values decreased in all patients. During or 24 h after the last GTX, the hypotension resolved and supplemental oxygen was stopped. One GTX was discontinued because of oxygen desaturation. CONCLUSION: GTX were a safe therapeutic measure with beneficial effects on serious infections in neutropenic children.- - - - - - - - - - ranking = 2keywords = neutropenia (Clic here for more details about this article) |
5/6. Rituximab is effective in the management of refractory autoimmune cytopenias occurring after allogeneic stem cell transplantation.Autoimmune haemolytic anaemia (AIHA), immune thrombocytopenia (ITP) and autoimmune neutropenia (AIN) are well-recognised complications of allogeneic stem cell transplantation (SCT), but have previously only been reported in the context of myeloablative conditioning regimens. Management of AIHA, ITP or AIN occurring after allogeneic SCT is unsatisfactory since they frequently prove refractory to conventional therapies including splenectomy. As a consequence, autoimmune cytopenias occurring after allogeneic SCT are associated with substantial morbidity and mortality. We report four patients who developed AIHA or ITP after allogeneic transplantation -- three of which occurred after a reduced-intensity conditioning (RIC) regimen. All patients demonstrated a complete response to Rituximab, having failed to respond to conventional treatment including high-dose prednisolone and intravenous immunoglobulin (IVIg). We conclude that Rituximab can be a valuable agent in the management of autoimmune cytopenias occurring after allogeneic SCT and that autoimmune cytopenias may be a hitherto unrecognised complication of RIC regimens.- - - - - - - - - - ranking = 1keywords = neutropenia (Clic here for more details about this article) |
6/6. Treatment of patients with hematologic neoplasm, fever, and neutropenia.Choices of empirical antibiotic therapy for patients with febrile neutropenia must be made with very little information about the source and site of infection. The clinician is aided by recognition of the subtle signs and symptoms of infection in immunocompromised patients. National guidelines should be applied according to the microbiological patterns and trends in drug resistance at each institution. Case studies are provided to illustrate these challenges in daily practice.- - - - - - - - - - ranking = 726.62552758954keywords = febrile neutropenia, neutropenia (Clic here for more details about this article) |