Yüce Ayhan

THE EVALUATION OF BLOOD DONOR DEFERRAL CAUSES

Safety of blood and blood products is a major problem all over the world. Screening for the markers of infectious diseases is an incomplete solution. One of the most important steps in improving the safety of blood and blood products is donor selection. In this study, causes of donor deferral were evaluated retrospectively in the blood center of a childrens hospital. Analysis of the deferrals showed that the most commonly defined causes were recent sexual exposure in high-risk activity, recent ingestion of medication, low hemoglobin level, abnormal blood pressure, being underweight, tattoos, piercing or acupuncture in the preceding 6 months, recent history of infection and presenting for a subsequent donation too soon, elevation of transaminases, presence of the markers of the infectious diseases.

Differences Between Pediatric Extra-Pulmonary and Pulmonary Tuberculosis: a Warning Sign for the Future

Background Tuberculosis (TB) remains a major global health problem. The childhood tuberculosis has some unique features different which makes the diagnosis more complicated. Here we described the epidemiologic, clinical and microbiologic features of children with extra pulmonary and pulmonary TB. Methods The data of the patients <14 years with active TB were collected and compared in pulmonary (PTB) and extrapulmonary TB (EXPTB) patients. Results A total of 128 cases was included. Forty-two cases occurred in children were < 5 years of age; 41 cases between 6–10 years and 45 cases > 10 years. PTB was present in 75,0% of the cases, and EXPTB was present in 25% of cases. There was no significant difference between the EXPTB and PTB by means of distribution of age groups (p=0,201). The rate of patients free of constitutional symptoms were significantly higher in EXPTB compared to PTB(p=0,000). There was no significant difference between EXPTB and PTB by means of sources detection(p=0,069). Conclusion TB is still a major public health problem. EXPTB has an insidious and silent onset without any constitutional symptoms, and both microbiological confirmation and the source by an adult are not frequently found. Moreover, detection of the adult source is mandatory for controlling the TB disease in children

New parameters for childhood ventilator associated pneumonia diagnosis.

Our aim is to determine whether the presence of soluble triggering receptor expressed on myeloid cells‐1 (s‐TREM‐1) of bronchoalveolar lavage fluid (BALF), serum procalcitonin levels (PCT), and Clinical Pulmonary Infection Score (CPIS) have diagnostic value in children with VAP.

Granulocyte transfusion experience in pediatric neutropenic fever: Splitted product can be an alternative?

The granulocyte transfusion (GTX) has been used for a long time due to uncontrolled neutropenic fever with antimicrobial agents. In some cases, the product needs to be splitted for using in the next 12 hours. The aim of this study is to evaluate the efficacy of splitted product and clinical response to GTX. In this study, 15 patients with malignancy with 19 neutropenic fever, who had received 56 GTX, were included. Seventeen of 56 GTX were splitted and used in maximum 12 hours during infections which did not respond to antibacterial and antifungal therapy in 7 days. The patients were divided in to response groups as a complete, partial and progressive. The predictive factors for response group were evaluated. GTX were well tolerated in all patients. The median granulocyte dose was 1.26 (0.38-5.22) × 10(9)/kg. Total response rate was 89.5%. The infection-related mortality rate was 10.5%. Although the granulocyte doses are the same in both of the product groups, an hour later ANC increment of primer product was higher than that of splitted product (p = 0.001). Among the products, 48.7% of primer product and 17.6% of splitted product had induced ≥ 1000/mm(3) ANC increment after an hour (p = 0.039). Granulocyte transfusion is safe and effective in controlling the febrile neutropenia attack. GTX should be applied in a short time to provide effective ANC increment. For now, main granulocyte product instead of splitted product should be preferred in case of uncontrolled neutropenic fever with antibacterial/antifungal agents.

Guillain-Barre syndrome in a 7-month-old boy successfully applied plasma exchange.

Despite being the most common cause of acute flaccid paralysis in children Guillain-Barré syndrome has a low incidence under 18 years old, and is even rarer under the age of 2. Established treatment regimens include intravenous immunoglobulin and plasma exchange in older children and adults. However very limited data are available for the efficacy and safety of plasma exchange in infants younger than 12 month-old. This article presents the experience of plasma exchange in the case of 7-month-old boy diagnosed with Guillain-Barré syndrome. A 7-month-old boy was referred to the pediatric intensive care unit with a 10-day history of progressive weakness, feeding difficulty and constipation. He was diagnosed with axonal Guillain-Barré syndrome on the basis of clinical and electromyographical findings. The patient recovered fully with intravenous immunoglobulin and plasma exchange. Plasma exchange may be a safe option in the treatment in infants with Guillain-Barré syndrome as young as 7-month-age.

İndirekt hiperbilirübinemili olgularda minör eritrosit antijenlerinin alloimmünizasyondaki rolü

Sum mary Aim: ABO/Rh incompatibilities are common causes of blood group incompatibility in newborns. On rare occasions, alloimmunization due to minor erythrocyte antigens may cause severe hemolytic disease requiring exchange transfusion. Most common minor erythrocyte antigens include non-D Rh antigens (c, C, e, E), Kell, Duffy, Kidd and MNS. In this study, we aimed to investigate minor erythrocyte antigens and their possible effects in newborns who were hospitalized for indirect hyperbilirubinemia and did not have any other detectable cause for neonatal jaundice. Material and Method: : Between July 1st 2009 and September 31st 2009, 107 newborns were enrolled to investigate the relationship between minor erythrocyte antigens and neonatal jaundice. Patients with common causes of hyperbilirubinemia such as ABO/Rh incompatibility, hypothyroidism, glucose-6-phosphate dehydrogenase deficiency, inborn errors of metabolism and sepsis were excluded. The study was approved by the ethics commite ((25.06.2006/35-2009). Minor erythrocyte antigens were studied by performing gel centrifugation method using human monoclonal antibodies. Antibodies were detected in mothers with positive antibody screening. Antigens which countered the antibodies present in the mother and which were found to be positive in the infant were considered as a cause of incompatibility. Kell, C, E,c, e antigens were investigated in all newborns regardless of their antibody screening results. Results: Minor erythrocyte incompatibility was detected in 7 out of 107 newborns (6.5%). Assessment among 230 newborns hospitalized for indirect hyperbilirubinemia revealed a rate of 3% for minor erythrocyte antigen positivity. The most common incompatibility was related to “s” antigen which was detected in 4 patients. Other antigens detected included C, Jka, S, Lub and N. Only 1 patient was found to carry Kell antigen. However his mother displayed negative antibody screening. Direct coombs positivity or severe hemolysis could not be detected in any of the patients with minor erythrocyte antigen incompatibility. Although the clinical course was similar, jaundice was realized much later in these infants when compared to other infants with indirect hyperbilirubinemia. Conclusions: Currently minor erythrocyte antigens are not being investigated routinely in neonatal jaundice. However, clinicians should keep in mind that minor erythrocyte antigens can cause indirect hyperbilirubinemia and sometimes severe hemolytic disease. Therefore they should remember to study these antigens in newborns with pathologic jaundice. (Turk Arch Ped 2013; 48: 23-29)

Transfusion reactions in neonates.

Objective: The improvement of the conditions in the neonatal intensive care units in recent years has resulted in an increase in the number of newborns that require blood product transfusions. While the neonatal alloimmune hemolytic reactions are more commonly resulted from ABO and Rh incompatibility. Minor blood group antigen and Rh subgroup disparity may also cause these reactions. In this study, we aimed to investigate the frequency and distribution of transfusion reactions in neonates. Methods: The transfusion reactions that were encountered at Dr. Behcet Uz Children’s Hospital from July 2006 thru June 2009 were retrospectively studied by reviewing the transfusion reaction forms. Results: Total of 31486 blood product transfusions were given, of which, 107 (0.3%) transfusion reactions were observed during the study period Fresh frozen plasma was the most common reason. Majority of the reactions were allergic. Transfusion reactions were observed in 5 of 7544 blood products transfused in newborns (0.06%), one of which was allergic reaction and the four were hemolytic reactions. In all five transfusions, the transfused product was packed red blood cells. There was no ABO or Rh incompability present in neither of the transfusions and the cross match was compatible. The subgroup antigens could not be identified, as the study had a retrospective design. Conclusion: The frequency of the transfusion reactions in newborns was less than that observed in children in other age groups. Inadequate antibody response during the newborn period is believed to be the reason for this lower frequency.