Marrow assessment for hemophagocytic lymphohistiocytosis demonstrates poor correlation with disease probability.

OBJECTIVES: To evaluate the amount of hemophagocytosis in 64 marrow core biopsy specimens and aspirates from 58 patients with clinical suspicion for secondary hemophagocytic lymphohistiocytosis (HLH) or reported findings of hemophagocytosis. METHODS: A review of medical records assigned patients to a low-risk (45 patients) or high-risk (13 patients) HLH group, and association with histologic findings was examined using the Fisher exact test. RESULTS: The amount of hemophagocytosis in aspirate or the core biopsy specimen did not correlate with disease probability (P = .17 and P = .63, respectively). Of the clinical/laboratory criteria assessed, the most significant correlations with HLH were highly elevated ferritin (P = .01), cytopenias (P = .02), and fever (P = .009). CONCLUSIONS: Our findings indicated that marrow histologic findings alone do not reliably predict the probability of HLH, and an isolated finding of hemophagocytosis, even when present in a high amount, lacks specificity for HLH.

A recession's impact on pediatric emergency household spending and attitudes about health-care reform.

BACKGROUND: We assessed changes in household spending and opinions about health-care insurance reform among parents in the pediatric emergency department (PED) during the current recession. METHODS: We conducted a survey of parents at a PED. Enrollment was in June and July 2009. We assessed demographics, employment and insurance status, and difficulty paying for household expenses. Open-ended questions addressed attitudes about health-care reform. RESULTS: Among 467 parents, job loss was associated with difficulty paying for food (OR 2.32, 95% CI 1.53-3.52), housing (3.21, 2.11-4.88), and utilities (2.19, 1.44-3.32). In total, 226 respondents cut household expenses. More respondents cut food expenses (20.8%) and utilities (15.8%) than child health care (12.0%). Of 154 respondents providing opinions about health-care reform, 66.9% endorsed reform, and 9.7% disagreed. CONCLUSION: Parents with job loss reported hardship paying for household expenses. One in eight families have cut child health-care expenses. A population of PED parents commonly favored health-care insurance reform.