Chandrakant C. Patel

Treatment of childhood acute immune thrombocytopenic purpura with anti-D immune globulin or pooled immune globulin

OBJECTIVE To evaluate the effectiveness of initial treatment of children with acute immune thrombocytopenic purpura (ITP) with anti-D immune globulin (anti-D) or pooled IgG immune globulin (IVIg). STUDY DESIGN The medical charts of 33 children diagnosed with acute ITP from May 1995 to October 1997 were reviewed. Patient data were eligible for analysis if, for the new diagnosis of acute ITP, the patient had received either anti-D at 45 to 50 microg/kg (WinRho SD, NABI) or IVIg at 0.8 to 1 g/kg (Gammagard SD, Baxter-Highland). The platelet response time for each treatment group was compared by the Mann-Whitney U test. RESULTS Time to achieve a platelet count >/=20 x 10(9 )/L (20,000/mm3 ) was 1.54 +/- 0.51 days in the IVIg group (n = 13) and 1.26 +/- 0.82 days in the anti-D group (n = 14) (P =.34). Time to achieve a platelet count >/=40 x 10(9 )/L (40,000/mm3 ) was 1.77 +/- 0.74 and 1.49 +/- 1.01 days for the IVIg and anti-D groups, respectively (P =.32). Children given IVIg were hospitalized for 2.1 +/- 0.87 days, whereas those given anti-D were hospitalized for 1.94 +/- 1.08 days. A net decrease in hemoglobin concentration was observed after receipt of IVIg (9.1 +/- 7.3 g/L [0.91 +/- 0.73 g/dL]) and after anti-D therapy (4.5 +/- 10.3 g/L [0.45 +/- 1.03 g/dL], P =.23). No patient required intervention for hemolysis. CONCLUSIONS In this retrospective analysis anti-D was as effective as IVIg for the treatment of acute ITP in children. However, randomized, controlled trials are needed to establish the role of anti-D in the treatment of acute ITP in children.

Neonatal immune neutropenia following the administration of intravenous immune globulin

Background : In adults—but not neonates—neutropenia has been reported to complicate treatment with intravenous immunoglobulin, but the mechanism is unknown. Purpose : To describe for the first time the case of a newborn infant who, after intravenous immunoglobulin, demonstrated serum antineutrophil antibodies and neutropenia. Patients and Methods : The 1,425-g, 36-week-gestation boy was healthy except for intrauterine growth retardation. Intravenous immunoglobulin (lg/dose × 3) was administered to treat alloimmune thrombocytopenia. Neutrophil-specific antibodies were detected by a granulocyte immunofluorescence assay. Results : After the intravenous immunoglobulin, the platelet count normalized but the neutrophil count declined to 450/mm3. Neutrophil-specific antibodies were detected in the serum of the infant but not in the maternal serum. Furthermore, cross-matching revealed that the maternal serum did not react with the infants granulocytes. Two of three random lots of intravenous immunoglobulin contained detectible anti-neutrophil antibodies. Conclusions : After intravenous immunoglobulin, the infants serum contained one or more anti-neutrophil antibodies that were not maternal in origin. We speculate that the neutropenia resulted from the administration of intravenous immunoglobulin containing antineutrophil antibodies.

Delayed pancreatic pseudocyst formation long‐term complication of L‐asparaginase treatment

L‐asparaginase‐induced pancreatitis has been reported during or closely following administration of the drug. Three cases of pseudocyst of the pancreas in two women and one man have previously been reported with the use of intravenous L‐asparaginase. An adolescent male developed acute pancreatitis and pseudocyst of the pancreas 16 weeks after cessation of intramuscular L‐asparaginase. Delayed pseudocyst of the pancreas can be a complication of intramuscular L‐asparaginase.

Hematologic abnormalities in acute necrotizing enterocolitis.

This presentation emphasizes the possible clinical significance of hematologic abnormalities in acute necrotizing enterocolitis and presents the author’s experience.

Pediatric Astrocytomas: The Louisville Experience: 1978–1988

PurposeThe purpose of this study is to retrospectively analyze all pediatric patients with the diagnosis of astrocytoma treated either definitively or postopcratively in our department from 1978 through 1988. Grade, age. T-stage, tumor location, and extent of resection are individually analyzed as prognostic indicators of overall survival. Materials and MethodsPediatric astrocytoma patients (grades I-1V) diagnosed by CT-guided biopsy or surgical resection were assessed. Patients were treated with external beam radiotherapy to involved fields using 4− or 6-MV photons. Daily doses ranged from 1.5 to 2.0 Gy; total doses from 41.4 to 66 Gy. Treatment was given to 17 patients (9 male, 8 female), aged 18 years and younger: 11 patients had low-grade (I & II) astrocytoma with incomplete margins; 3 patients had anaplastic astrocytoma; and 3 patients had glioblastoma multi-forme. ResultsOverall survival at 140 months was 63%. Median follow-up of patients living NED was 69 months, with a range of 39–140 months. Nine of the eleven (82%) low-grade patients survived NED; I of 3 anaplastic patients is NED at 44 months follow-up; 1 died of intercurrent disease at 80 months; the third died of disease at 49 months. All three glioblastomas succumbed to local disease at 9, 15, and 27 months from diagnosis. Univariate analysis showed only grade to be prognostically significant (p < .03) in determining overall survival. ConclusionPostoperative radiotherapy for unresected or partially resected low-grade astrocytomas produces excellent local control. Higher grade astrocytomas require further investigational studies to improve survival and local control. Grade is prognostically significant with respect to overall survival.

Plasma amino acids during high-dose methotrexate-citrovorum “rescue”

Abstract Plasma amino acids were monitored over a 4-day period in a patient with osteogenic sarcoma just before and during infusion of a high dose of methotrexate and during subsequent rescue with citrovorum factor. The concentrations in the plasma of phenylalanine rose seven-fold to a maximum observed at 22 hr and of cysteine rose almost threefold in 98 hr. The phenylalanine concentration maintained a threefold elevation during the 24-hr period following completion of the citrovorum rescue. These data indicate the inhibition by high dose methotrexate of liver phenylalanine hydroxylase, an enzyme system which is apparently not rescued by citrovorum factor. Plasma levels of tyrosine throughout the study did not fall below the pretreatment value.

Efficacy of Anti-D Immunoglobulin (Anti-D) and Intravenous Immunoglobulin(IVIg) in the Treatment of Acute Immune Thrombocytopenic Purpura (ITP) in Children. † 665

Efficacy of Anti-D Immunoglobulin (Anti-D) and Intravenous Immunoglobulin(IVIg) in the Treatment of Acute Immune Thrombocytopenic Purpura (ITP) in Children. † 665