Congenital microangiopathic haemolytic anemia: a variant of thrombotic thrombocytopenic purpura?

We describe a child with recurrent microangiopathic haemolytic anemia (MAHA) and thrombocytopenia (TCP) who presented on the first day of life. Remission was maintained only by regular infusions of fresh frozen plasma (FFP). This case shows similarities with others described in the literature as examples of thrombotic thrombocytopenic purpura (TTP), although the absence of renal or neurological involvement distinguishes this disorder from classical TTP.

Treatment of childhood acute myeloid leukaemia using the BFM-83 protocol

Thirty children presenting with acute nonlymphoblastic leukaemia from June 1984 to December 1989 were treated at one UK centre using a West German protocol, AML-BFM-83. This consisted of Induction, an intensive outpatient-based Consolidation regimen with seven different drugs and cranial irradiation, and Continuation therapy with thioguanine and cytosine arabinoside for 2 years with additional Adriamycin in the first year. Twenty-five children achieved complete remission (83%). There were two early deaths from haemorrhage and infection and three from Induction failure. After a median follow-up time of 60 months, nine relapses have occurred, all in the bone marrow. Life table analysis revealed a probability for survival at 5 years of 47%, event-free survival 43%, and event-free interval 50%. Median bed occupancy for chemotherapy and toxicity was 41 days, with median hospital stays of 29 days for Induction, 11 days for Consolidation and less than 1 day for Continuation. This data suggests that long-term remissions can be achieved in just under half of children with acute nonlymphoblastic leukaemia while creating only modest demands on inpatient resources.

Transient myeloproliferative disorder in Down's syndrome: three cases with megakaryocytic markers

In this paper we describe three infants with Down's syndrome and transient myeloproliferative disorder. The blast cells of all three displayed positive megakaryocytic markers. One patient developed acute megakaryoblastic leukemia in his second year, with blasts identical to those of the initial episode. The other two cases remain well at 12 and 15 months of age.

Continuous papaveretum infusion for the control of pain in painful sickling crisis

We describe our experience of using continuous papaveretum infusions to control pain in 24 children admitted on 45 occasions with painful sickling crisis. The children were aged from 1.7 to 14.3 years. Infusion duration ranged from one to nine days (median three days), total dose from 0.3 to 21 mg/kg (median 2.4 mg/kg), with a pronounced tendency for dosage to increase with increasing age. No respiratory depression was observed. One infusion was discontinued because of cerebral toxicity.