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Danewa A, Kalra M, Sachdeva A, Sachdeva P, Bansal D, Bhat S, Sachdeva D, Rani S, Yadav SP, Katewa S, Kumar A, Muniratnam D, Agarwal BR, Seth T, Mahajan A, Dua V, Kharya G, Misra R, Desai D, Gunasekaran V, Srivastava V. Diagnosis and Management of Acquired Aplastic Anemia: Consensus Statement of Indian Academy of Pediatrics. Indian Pediatr 2022; 59:467-475. [PMID: 35105820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
JUSTIFICATION In India, there is a lack of uniformity of treatment strategies for aplastic anemia (AA), and many children are managed only with supportive care due to non-availability of hematopoietic stem cell transplantation (HSCT). PROCESS Eminent national faculty members were invited to participate in the process of forming a consensus statement in Hyderabad in July, 2016. Draft guidelines were circulated to all members, and comments received in a online meeting in October, 2020 were incorporated into the final draft. These were approved by all experts. OBJECTIVE To facilitate appropriate management of children with acquired aplastic anemia. RECOMMENDATIONS Key recommendations are: i) A bone marrow biopsy is must to make a diagnosis of AA; ii) Rule out inherited bone marrow failure syndromes (IBMFS), connective tissue disorders, viral infections, paroxysmal nocturnal hemoglobinuria (PNH), drug or heavy metal induced marrow suppression in all cases of AA; iii) Conservative approach to transfusions should be followed, with a target to keep hemoglobin >6 g/dL in children with no co-morbidities; iv) HLA-matched sibling donor HSCT is the preferred choice of treatment for newly diagnosed very severe/ severe AA; v) In absence of HLA-matched family donor, a matched unrelated donor (MUD) transplant or immunosuppressive therapy (IST) should be considered as alternate choice based on physician expertise; vi) Fludarabine, cyclophos-phamide and anti-thymocyte globulin (ATG) based conditioning with cyclosporine and methotrexate as graft versus host disease (GvHD) prophylaxis is the preferred regimen; vii) Horse ATG and cyclosporine are the recommended drugs for IST. One should wait for 3-6 months for the response assessment and consideration of next line therapy.
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Affiliation(s)
| | | | - Anupam Sachdeva
- Sir Ganga Ram Hospital, New Delhi. Correspondence to: Dr Anupam Sachdeva, Director, Pediatric Hematology Oncology and Bone Marrow Transplantation unit, Institute for Child Health, Sir Ganga Ram Hospital, New Delhi 110 060.
| | | | | | - Sunil Bhat
- Narayana Health City, Bangalore, Karnataka
| | | | | | | | | | | | | | | | | | | | - Vikas Dua
- Fortis Memorial Research Institute, Gurugram, Haryana
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Sharma AK, Katewa S. Rare Presentation of Inflammatory Myofibroblastic Tumor as Intussusception in a Child with Idiopathic Aplastic Anemia. J Indian Assoc Pediatr Surg 2022; 27:263-265. [PMID: 35937104 PMCID: PMC9350633 DOI: 10.4103/jiaps.jiaps_368_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/21/2021] [Accepted: 06/15/2021] [Indexed: 11/04/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is an uncommon mesenchymal solid tumor documented in children and young adults. A 7-year-old boy diagnosed case of acquired aplastic anemia, referred to our hospital for hematopoietic stem cell transplantation. He was admitted to the hospital with febrile neutropenia. Blood culture showed persistent Escherichia coli infection. During hospital stay, he had bilious vomiting with tender abdomen suggestive of subacute intestional obstruction. Computed tomography of the abdomen was suggestive of ileocolic intussusception. Emergency laparotomy done which revealed a large polypoid mass involving cecum and part of ascending colon with ileocolic intussusception, child underwent ileotransverse colon resection with end-to-side anastomosis. Immunohistochemistry was suggestive of IMT. The child had persistent fever and protracted course during hospital stay and finally died. E. coli sepsis is associated with IMT and leads to protracted course in immunosuppressed patients such as aplastic anemia. As the imaging and laboratory tests are nonspecific, it should be considered in an immunocompromised children who have E. coli sepsis and abdominal complaints and rare presentation as intussusception.
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Affiliation(s)
- Ashok Kumar Sharma
- Department of Pediatric Surgery, Manipal Hospital, Jaipur, Rajasthan, India,Address for correspondence: Dr. Ashok Kumar Sharma, K-51, IncomeTaxColony, Tonk Road, Durgapura, Jaipur - 302 018, Rajasthan, India. E-mail:
| | - Satyendra Katewa
- Department of Paediatrics Haematology Oncology and Bone Marrow Transplant, Manipal Hospital, Jaipur, Rajasthan, India
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Sharma A, Rastogi N, Chatterjee G, Kapoor R, Nivargi S, Kohli S, Misra R, Katewa S, Sachdeva A, Yadav SP. Outcomes of pediatric haematopoietic stem cell transplant: a decade long experience. Pediatric Hematology Oncology Journal 2019. [DOI: 10.1016/j.phoj.2019.08.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Rastogi N, Katewa S, Thakkar D, Kohli S, Nivargi S, Yadav SP. Reduced-toxicity alternate-donor stem cell transplantation with posttransplant cyclophosphamide for primary immunodeficiency disorders. Pediatr Blood Cancer 2018; 65. [PMID: 28901730 DOI: 10.1002/pbc.26783] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 07/30/2017] [Accepted: 08/01/2017] [Indexed: 11/08/2022]
Abstract
We describe here the outcomes of reduced-toxicity alternate-donor stem cell transplant (SCT) with posttransplant cyclophosphamide (PTCy) for primary immunodeficiency disorders (PIDs) in eight children (haploidentical-seven and matched unrelated donor-one). The conditioning was with serotherapy (alemtuzumab-3/rabbit-anti-thymoglobulin-5); fludarabine, cyclophosphamide, and total body irradiation-5 (additional thiotepa-3); fludarabine and treosulfan-2; and fludarabine and busulfan-1. All received PTCy 50 mg/kg on days 3 and 4 as graft versus host disease prophylaxis along with tacrolimus and mycophenolate. Mean CD34 dose was 13.8 × 106 /kg. Two children died because of PIDs. Acute graft versus host disease up to grades I and II was seen in three children. All six survivors are fully donor and disease free at median follow-up of 753 days. Alternate donor SCT with PTCy is feasible in PID and has good outcomes.
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Affiliation(s)
- Neha Rastogi
- Pediatric Hematology Oncology Unit, Department of Pediatrics, Fortis Memorial Research Institute, Gurgaon, Haryana, India.,Department of Pediatric Hematology Oncology & BMT, Medanta The Medicity Hospital, Gurgaon, Haryana, India
| | - Satyendra Katewa
- Pediatric Hematology Oncology Unit, Department of Pediatrics, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - Dhwanee Thakkar
- Pediatric Hematology Oncology Unit, Department of Pediatrics, Fortis Memorial Research Institute, Gurgaon, Haryana, India.,Department of Pediatric Hematology Oncology & BMT, Medanta The Medicity Hospital, Gurgaon, Haryana, India
| | - Shruti Kohli
- Pediatric Hematology Oncology Unit, Department of Pediatrics, Fortis Memorial Research Institute, Gurgaon, Haryana, India.,Department of Pediatric Hematology Oncology & BMT, Medanta The Medicity Hospital, Gurgaon, Haryana, India
| | - Sagar Nivargi
- Pediatric Hematology Oncology Unit, Department of Pediatrics, Fortis Memorial Research Institute, Gurgaon, Haryana, India.,Department of Pediatric Hematology Oncology & BMT, Medanta The Medicity Hospital, Gurgaon, Haryana, India
| | - Satya Prakash Yadav
- Pediatric Hematology Oncology Unit, Department of Pediatrics, Fortis Memorial Research Institute, Gurgaon, Haryana, India.,Department of Pediatric Hematology Oncology & BMT, Medanta The Medicity Hospital, Gurgaon, Haryana, India
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Egeler RM, Katewa S, Leenen PJM, Beverley P, Collin M, Ginhoux F, Arceci RJ, Rollins BJ. Langerhans cell histiocytosis is a neoplasm and consequently its recurrence is a relapse: In memory of Bob Arceci. Pediatr Blood Cancer 2016; 63:1704-12. [PMID: 27314817 DOI: 10.1002/pbc.26104] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/19/2016] [Accepted: 05/19/2016] [Indexed: 01/01/2023]
Abstract
Langerhans cell histiocytosis (LCH) remains a poorly understood disorder with heterogeneous clinical presentations characterized by focal or disseminated lesions that contain excessive CD1a+ langerin+ cells with dendritic cell features known as "LCH cells." Two of the major questions investigated over the past century have been (i) the origin of LCH cells and (ii) whether LCH is primarily an immune dysregulatory disorder or a neoplasm. Current opinion is that LCH cells are likely to arise from hematopoietic precursor cells, although the stage of derailment and site of transformation remain unclear and may vary in patients with different extent of disease. Over the years, evidence has provided the view that LCH is a neoplasm. The demonstration of clonality of LCH cells, insufficient evidence alone for neoplasia, is now bolstered by finding driver somatic mutations in BRAF in up to 55% of patients with LCH, and activation of the RAS-RAF-MEK-ERK (where MEK and ERK are mitogen-activated protein kinase and extracellular signal-regulated kinase, respectively) pathway in nearly 100% of patients with LCH. Herein, we review the evidence that recurrent genetic abnormalities characterized by activating oncogenic mutations should satisfy prerequisites for LCH to be called a neoplasm. As a consequence, recurrent episodes of LCH should be considered relapsed disease rather than disease reactivation. Mapping the complete genetic landscape of this intriguing disease will provide additional support for the conclusion that LCH is a neoplasm and is likely to provide more potential opportunities for molecularly targeted therapies.
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Affiliation(s)
- R Maarten Egeler
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children/University of Toronto, Toronto, Ontario, Canada
| | - Satyendra Katewa
- Department of Pediatric Hematology/Oncology & BMT, Soni Manipal Hospital, Main Sikar Road, Sector 5, Jaipur, Rajasthan, India
| | - Pieter J M Leenen
- Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Matthew Collin
- Department of Haematological Sciences, Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Florent Ginhoux
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Singapore, 138648
| | - Robert J Arceci
- Department of Child Health, University of Arizona, College of Medicine - Phoenix, Ron Matricaria Institute of Molecular Medicine, Phoenix, Arizona
| | - Barrett J Rollins
- Division of Medical Oncology, Dana-Farber Cancer Institute, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Kohli S, Rastogi N, Nivargi S, Chopra YR, Thakkar DS, Sen IB, Katewa S, Misra R, Yadav SP. MIBG followed by haploidentical stem cell transplant with post transplant cyclophosphamide in relapsed/refractory neuroblastoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e22002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Shruti Kohli
- Fortis Memorial Research Institute, Gurgaon, India
| | - Neha Rastogi
- Fortis Memorial Research Institute, Gurgaon, India
| | | | | | | | - Ishita B Sen
- Fortis Memorial Research Institute, Gurgaon, India
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Yadav SP, Rastogi N, Chopra Y, Kohli S, Nivargi S, Katewa S. Reduced Intensity Conditioning Allogeneic Stem Cell Transplant for Primary Immunodeficiency Disorders: A Single Centre Experience from India. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rastogi N, Thakkar D, Kohli S, Nivargi S, Katewa S, Yadav SP. RIC HSCT in primary immunodeficiency children in developing world – A ray of hope. Pediatric Hematology Oncology Journal 2016. [DOI: 10.1016/j.phoj.2016.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lankester AC, Locatelli F, Bader P, Rettinger E, Egeler M, Katewa S, Pulsipher MA, Nierkens S, Schultz K, Handgretinger R, Grupp SA, Boelens JJ, Bollard CM. Will post-transplantation cell therapies for pediatric patients become standard of care? Biol Blood Marrow Transplant 2014; 21:402-11. [PMID: 25064748 DOI: 10.1016/j.bbmt.2014.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 07/15/2014] [Indexed: 01/29/2023]
Abstract
Although allogeneic hematopoietic stem cell transplantation (HSCT) is a curative approach for many pediatric patients with hematologic malignancies and some nonmalignant disorders, some critical obstacles remain to be overcome, including relapse, engraftment failure, graft-versus-host disease (GVHD), and infection. Harnessing the immune system to induce a graft-versus-tumor effect or rapidly restore antiviral immunity through the use of donor lymphocyte infusion (DLI) has been remarkably successful in some settings. Unfortunately, however, the responses to DLI can be variable, and GVHD is common. Thus, manipulations to minimize GVHD while restoring antiviral immunity and enhancing the graft-versus-tumor effect are needed to improve outcomes after allogeneic HSCT. Cellular therapies, defined as treatment modalities in which hematopoietic or nonhematopoietic cells are used as therapeutic agents, offer this promise for improving outcomes post-HSCT. This review presents an overview of the field for pediatric cell therapies in the transplant setting and discusses how we can broaden applicability beyond phase I.
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Affiliation(s)
- Arjan C Lankester
- Division of Stem Cell Transplantation, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology, IRCCS Istituto Di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico, Bambino Gesù, Rome, Italy
| | - Peter Bader
- Department of Stem Cell Transplantation and Immunology, Hospital for Children and Adolescents, Frankfurt am Main, Germany
| | - Eva Rettinger
- Department of Stem Cell Transplantation and Immunology, Hospital for Children and Adolescents, Frankfurt am Main, Germany
| | - Maarten Egeler
- Division of Haematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Satyendra Katewa
- Division of Haematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Michael A Pulsipher
- Primary Children's Hospital, Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute/University of Utah School of Medicine, Salt Lake City, Utah
| | - Stefan Nierkens
- Utrecht-Dendritic cells AgaiNst CancEr (U-DANCE), Lab Translational Immunology, Utrecht center for Diagnostic Advances in Immunology Research (U-DAIR), Lab Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kirk Schultz
- BC Children's Hospital, Division of Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rupert Handgretinger
- Department of Pediatric Hematology/Oncology, Children's University Hospital, University of Tübingen, Tübingen, Germany
| | - Stephan A Grupp
- Division of Oncology, The Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jaap Jan Boelens
- Department of Pediatrics, Blood and Marrow Transplantation Program, Utrecht-Dendritic cells AgaiNst CancEr (U-DANCE), Lab Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Catherine M Bollard
- Departments of Pediatrics and Microbiology, Immunology and Tropical Medicine, Children's National Health System and George Washington University, Division of Pediatric Hematology-Oncology, Washington, DC
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Sharma R, Chopra YR, Ramzaan M, Katewa S, Yadav SP. Outcome of childhood acute lymphoblastic leukemia: A single center experience from India. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e21001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rajat Sharma
- Fortis Memorial Research Institute, Gurgaon, India
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11
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Yadav SP, Rastogi N, Kharya G, Misra R, Ramzan M, Katewa S, Dua V, Bhat S, Kellie SJ, Howard SC. Barriers to cure for children with cancer in India and strategies to improve outcomes: a report by the Indian Pediatric Hematology Oncology Group. Pediatr Hematol Oncol 2014; 31:217-24. [PMID: 24673115 DOI: 10.3109/08880018.2014.893596] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The survival of children with cancer in India is inferior to that of children in high-income countries. The Indian Pediatric Hematology Oncology Group (IPHOG) held a series of online meetings via www.Cure4kids.org to identify barriers to cure and develop strategies to improve outcomes. Five major hurdles were identified: delayed diagnosis, abandonment, sepsis, lack of co-operative groups, and relapse. Development of regional networks like IPHOG has allowed rapid identification of local causes of treatment failure for children with cancer in India and identification of strategies likely to improve care and outcomes in the participating centers. Next steps will include interventions to raise community awareness of childhood cancer, promote early diagnosis and referral, and reduce abandonment and toxic death at each center. Starting of fellowship programs in pediatric hemato-oncology, short training programs for pediatricians, publishing outcome data, formation of parent and patient support groups, choosing the right and effective treatment protocol, and setting up of bone marrow transplant services are some of the effective steps taken in the last decade, which needs to be supported further.
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Affiliation(s)
- Satya Prakash Yadav
- 1Pediatric Hematology and Bone Marrow Transplant Unit, Fortis Memorial Research Institute, Gurgaon, India
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Ramzan M, Katewa S, Chopra Y, Sharma R, Yadav SP. Plerixafor: A Magic Drug for Urgent PBSC Mobilization from an Adolescent Donor after Failed Bone Marrow Harvest. Biol Blood Marrow Transplant 2014. [DOI: 10.1016/j.bbmt.2013.12.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Choudhary D, Sharma SK, Gupta N, Kharya G, Pavecha P, Handoo A, Setia R, Katewa S. Treosulfan-Thiotepa-Fludarabine–Based Conditioning Regimen for Allogeneic Transplantation in Patients with Thalassemia Major: A Single-Center Experience from North India. Biol Blood Marrow Transplant 2013; 19:492-5. [DOI: 10.1016/j.bbmt.2012.11.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 11/08/2012] [Indexed: 11/26/2022]
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Choudhary D, Katewa S, Kharya G, Anjan M, Setia R. Single Center Experience of Thiotepa, Treosulphan & Fludarabine Based Regimen in Thalassemia Major. Biol Blood Marrow Transplant 2012. [DOI: 10.1016/j.bbmt.2011.12.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Kharya G, Yadav SP, Katewa S, Sachdeva A. Management of severe refractory thrombocytopenia in dengue hemorrhagic fever with intravenous anti-D immune globulin. Pediatr Hematol Oncol 2011; 28:727-32. [PMID: 21970507 DOI: 10.3109/08880018.2011.609581] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Dengue hemorrhagic fever (DHF) is a potentially lethal complication of dengue fever due to shock and/or bleeding. Bleeding in DHF is due to thrombocytopenia and/or coagulopathy. The authors present their experience of usage of intravenous anti-D in 5 children with DHF and severe refractory thrombocytopenia (<10,000/mm(3)). It was administered in a dose of 50 to 75 μg/kg. Mean platelet count was 6800/mm(3) before and 33,600, 44,600, and 79,000/mm(3) after intravenous anti-D administration at 24, 48, and 72 hours, respectively. Average drop in hemoglobin after administration of anti-D was 2.28 g/dL. Intravenous anti-D can possibly be a treatment option for refractory thrombocytopenia in DHF.
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Affiliation(s)
- Gaurav Kharya
- Pediatric Hematology Oncology and Bone Marrow Transplant Unit, Center for Child Health, Sir Ganga Ram Hospital, Delhi, India
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Bhakhri BK, Katewa S, Sharma R, Mahajan S. Primary antiphospholipid antibody syndrome presenting with adrenal insufficiency in a child: Case report and review of literature. Lupus 2011; 20:1203-8. [DOI: 10.1177/0961203310397965] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 7-year-old boy presented with adrenal insufficiency. He subsequently developed venous thrombosis in the limbs and was diagnosed with primary antiphospholipid syndrome (PAPS) based on clinical and laboratory parameters. Both adrenals were normal on imaging. He required thrombolysis and anticoagulation. The progressive course of PAPS was controlled with methylprednisolone. There are few reports of PAPS in pediatric patients, and associated adrenal involvement is rare. The unusual presentation, course and management of the patient and of four other reported children with adrenal insufficiency heralding manifestation of PAPS are discussed.
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Affiliation(s)
- BK Bhakhri
- All India Institute of Medical Sciences, New Delhi, India
| | - S Katewa
- Dr B L Kapoor Memorial Hospital, Pusa Road, New Delhi, India
| | - R Sharma
- Dr B L Kapoor Memorial Hospital, Pusa Road, New Delhi, India
| | - S Mahajan
- Dr B L Kapoor Memorial Hospital, Pusa Road, New Delhi, India
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Yadav SP, Sachdeva A, Bhat S, Katewa S. Successful control of massive gastrointestinal bleeding following umbilical cord blood transplantation (UCBT) by use of recombinant activated factor VII (rFVIIa) and octreotide infusion. Pediatr Hematol Oncol 2010; 27:24-30. [PMID: 20121552 DOI: 10.3109/08880010903376988] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Post hematopoietic stem cell transplantation (HSCT) gastrointestinal (GI) bleeding is a dreaded complication. There are only five other reports (one randomised trial and four case reports) of use of rFVIIa for massive lower GI bleeding post-allogeneic HSCT. In only one publication, two adult patients showed complete response. Eroglu has reported a response rate of 50% to octreotide in gastrointestinal bleeding in patients without portal hypertension. We present a 10 month-old female child, who had three episodes of life threatening lower GI bleeding post unrelated Umbilical Stem Cell Transplant (UCBT) controlled successfully each time by use of rFVIIa and octreotide infusion and review of literature. To our knowledge this is the first and youngest case reported, in which both rFVIIa and octreotide have been used successfully to control life threatening lower GI bleeding post UCBT.
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Affiliation(s)
- Satya Prakash Yadav
- Pediatric Hematology Oncology & BMT Unit, Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India.
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