Acute upper GI bleed in a 4-year-old boy: a case of atypical Burkitts lymphoma in a 4-year-old.

Lymphomas have been seen in the pediatric population; more frequently in patients with H. Pylori, Celiac disease, and/or patients with congenital or acquired immune deficiencies. We report a case of a 4-year old male with an acute gastric-intestinal bleed accompanied by a rare lymphoma.

Analysis of significant decrease in platelet count and thrombocytopenia, graded according to NCI-CTC, as prognostic risk markers for mortality and morbidity.

BACKGROUND: In adult intensive care unit, both thrombocytopenia (TP) and ≥30% decrease in platelet count are associated with increased mortality, morbidity, and length of stay (LOS). The above mentioned observations have not been well reported in pediatric population. National Cancer Institute (NCI) common terminology criteria (CTC) is mainly used to report the adverse effects of cancer therapy, but not for grading TP. METHOD: Retrospective review of medical records was done for 204 patients. TP was graded according to the NCI-CTC. Each grade of TP and significant decrease (≥30%) in platelet count were studied for their association with LOS, mortality, and morbidity such as hospital-acquired pneumonia and positive blood culture. Four study groups were formed according to presence and/or absence of TP and significant decrease in platelet count. These groups were also studied for their association with mortality and LOS. RESULTS: Both ≥30% decrease in platelets and TP (58.3% and 25% of patients, respectively) were associated with higher mortality and longer LOS (P<0.0001). Both have association also with infection. There was a trend of increased mortality with higher TP grade. Grade 4 TP was significantly associated with increased LOS (P=0.0001). When compared with neither group, groups with positive significant decrease were associated with higher mortality and LOS, even in the absence of TP. CONCLUSIONS: We can use the NCI-CTC for classification of TP, which would enable the standardization of TP grading system. A ≥30% decrease in platelet count, even without TP, is a prognostic risk marker for mortality, morbidity, and LOS.