Childhood Venous Thromboembolism in Yeungnam Region in Korea: Multicenter Study / 임상소아혈액종양

BACKGROUND: Venous thromboembolism (VTE) is rare in pediatric patients compared to adults, but it's incidence is gradually increasing. The purpose of this study was to analyze the incidence, risk factors, and prognosis of pediatric patients with VTE in Korea. METHODS: Between January 2000 and July 2017, 249,312 medical records of the patients older than 1 year who were hospitalized in the department of pediatrics of 10 university hospitals in Yeungnam region were retrospectively reviewed. RESULTS: The overall incidence of VTE was 4.9 per 10,000 admissions. Of the total 123 patients, 80 (65.0%) were male and the median age was 10.8 years (range, 1.0–23.5 years). Magnetic resonance imaging was performed most frequently to confirm the diagnosis of VTE (43.1%). Thrombosis occurred in the cerebral vessels (46.3%), lower extremities (23.8%), pulmonary (19.5%), abdomen (9.8%), and upper extremities (4.1%). One hundred and six patients had underlying causes such as cancer (27.6%), infection (26.8%), intravenous catheter insertion (17.9%), and surgery (14.6%). Protein C was evaluated in 39 patients (31.7%), protein S in 40 (32.5%), antithrombin (AT) III in 52 (42.3%), and homocysteine in 21 (17.1%). Among them, one patient with a family history of AT III deficiency had SERPINC gene mutation. Seventy-seven patients (62.6%) started anticoagulation treatment. Most (52.0%) were treated for more than 90 days. CONCLUSION: Healthcare providers must be aware of the potential for VTE development in childhood. In the near future, a nationwide survey should be investigated to determine the incidence rate and the trends in VTE among Korean children.

Emergency Department Visits in Hemophilia Patients / 임상소아혈액종양

BACKGROUND: Hemophilia A and hemophilia B are characterized by prolongation of bleeding and hemorrhages in the joints and soft tissues. There is no ultimate treatment, if patients did not properly manage who can lead to chronic disease and lifelong disabilities. Many patients with hemophilia continue to seek medical attention, for several reasons in the emergency department (ED). In this retrospective study, we examined the overall ED use by patients with hemophilia in a single center, particularly in order to examine visits related to clinical characteristics.METHODS: There were 210 patients with hemophilia for a 16-year period. Among them, 96 patients visited the ED. We evaluated the history, laboratory findings, image study, clinical course.RESULTS: There are 170 hemophilia A, 40 hemophilia B. Bleeding is the most common reason for ED visits. Bleeding site is joint, intracranial, muscle, subcutaneous, gastrointestinal in regular sequence. Life threatening bleeding was reported 23 episodes of Intracranial hemorrhage (ICH), 12 episodes of gastrointestinal hemorrhage, 6 episodes of iliopsoas bleeding and 2 episodes of pulmonary hemorrhage. In the case of ICH, seizure is usual symptom. In the case of gastrointestinal bleeding, hematochezia is the common symptom. In the case of iliopsoas bleeding, lower extremity pain and edema, limitation of motion are common symptoms.CONCLUSION: In order to minimize complications, we must perform fast, accurate judgement and treatment when the patients with hemophilia visit ED.

Prophylactic Antibiotics Therapy after Splenectomy / 임상소아혈액종양

BACKGROUND: Patients who are born without spleen or who have impaired splenic function due to disease or splenectomy become vulnerable to sepsis caused by bacteria. Overwhelming post-splenectomy infection (OPSI) occurs at an estimated incidence of 0.23-0.42% per year with a lifetime risk of 5%. The risk of OPSI with encapsulated bacteria is generally considered greatest in the first 2 years after splenectomy but the increased risk remains lifelong. Because vaccination doesn't completely protect against infection with encapsulated bacteria that prevent OPSI, use of prophylactic antibiotics are recommended for prevention of infection after splenectomy.METHODS: A retrospective review of 41 patients who underwent splenectomy from January 1990 to December 2012 in Inje University Busan Paik Hospital were identified through the medical records.RESULTS: Of 41 patients, 100% (41/41) were vaccinated in pneumococcal vaccines, 27% (11/41) were vaccinated in HIB vaccines. Prophylactic antibiotics (penicillin G benzathine IM every 4 weeks) were prescribed in 73% (30/41) of patients. We could not find any septic events.CONCLUSION: Because of the high mortality, the fulminant course, and the refractoriness to common treatment of overwhelming infections caused by encapsulated bacteria, prevention through vaccination and antibiotic prophylaxis is the basis of the management of patients who have had splenectomy or have hyposplenism. Prophylactic antibiotics using Penicillin G benzathine every 4 weeks is effective for preventing septic events in splenectomized patients. But further improvement in coverage of recommended vaccines and continuous prophylactic antibiotics after splenectomy is needed to reduce the risk of serious infection.

Emergency Department Visits in Hemophilia Patients / 임상소아혈액종양

BACKGROUND: Hemophilia A and hemophilia B are characterized by prolongation of bleeding and hemorrhages in the joints and soft tissues. There is no ultimate treatment, if patients did not properly manage who can lead to chronic disease and lifelong disabilities. Many patients with hemophilia continue to seek medical attention, for several reasons in the emergency department (ED). In this retrospective study, we examined the overall ED use by patients with hemophilia in a single center, particularly in order to examine visits related to clinical characteristics. METHODS: There were 210 patients with hemophilia for a 16-year period. Among them, 96 patients visited the ED. We evaluated the history, laboratory findings, image study, clinical course. RESULTS: There are 170 hemophilia A, 40 hemophilia B. Bleeding is the most common reason for ED visits. Bleeding site is joint, intracranial, muscle, subcutaneous, gastrointestinal in regular sequence. Life threatening bleeding was reported 23 episodes of Intracranial hemorrhage (ICH), 12 episodes of gastrointestinal hemorrhage, 6 episodes of iliopsoas bleeding and 2 episodes of pulmonary hemorrhage. In the case of ICH, seizure is usual symptom. In the case of gastrointestinal bleeding, hematochezia is the common symptom. In the case of iliopsoas bleeding, lower extremity pain and edema, limitation of motion are common symptoms. CONCLUSION: In order to minimize complications, we must perform fast, accurate judgement and treatment when the patients with hemophilia visit ED.

Prophylactic Antibiotics Therapy after Splenectomy / 임상소아혈액종양

BACKGROUND: Patients who are born without spleen or who have impaired splenic function due to disease or splenectomy become vulnerable to sepsis caused by bacteria. Overwhelming post-splenectomy infection (OPSI) occurs at an estimated incidence of 0.23-0.42% per year with a lifetime risk of 5%. The risk of OPSI with encapsulated bacteria is generally considered greatest in the first 2 years after splenectomy but the increased risk remains lifelong. Because vaccination doesn't completely protect against infection with encapsulated bacteria that prevent OPSI, use of prophylactic antibiotics are recommended for prevention of infection after splenectomy. METHODS: A retrospective review of 41 patients who underwent splenectomy from January 1990 to December 2012 in Inje University Busan Paik Hospital were identified through the medical records. RESULTS: Of 41 patients, 100% (41/41) were vaccinated in pneumococcal vaccines, 27% (11/41) were vaccinated in HIB vaccines. Prophylactic antibiotics (penicillin G benzathine IM every 4 weeks) were prescribed in 73% (30/41) of patients. We could not find any septic events. CONCLUSION: Because of the high mortality, the fulminant course, and the refractoriness to common treatment of overwhelming infections caused by encapsulated bacteria, prevention through vaccination and antibiotic prophylaxis is the basis of the management of patients who have had splenectomy or have hyposplenism. Prophylactic antibiotics using Penicillin G benzathine every 4 weeks is effective for preventing septic events in splenectomized patients. But further improvement in coverage of recommended vaccines and continuous prophylactic antibiotics after splenectomy is needed to reduce the risk of serious infection.

Emergency Department Visits in Hemophilia Patients / 임상소아혈액종양

BACKGROUND: Hemophilia A and hemophilia B are characterized by prolongation of bleeding and hemorrhages in the joints and soft tissues. There is no ultimate treatment, if patients did not properly manage who can lead to chronic disease and lifelong disabilities. Many patients with hemophilia continue to seek medical attention, for several reasons in the emergency department (ED). In this retrospective study, we examined the overall ED use by patients with hemophilia in a single center, particularly in order to examine visits related to clinical characteristics. METHODS: There were 210 patients with hemophilia for a 16-year period. Among them, 96 patients visited the ED. We evaluated the history, laboratory findings, image study, clinical course. RESULTS: There are 170 hemophilia A, 40 hemophilia B. Bleeding is the most common reason for ED visits. Bleeding site is joint, intracranial, muscle, subcutaneous, gastrointestinal in regular sequence. Life threatening bleeding was reported 23 episodes of Intracranial hemorrhage (ICH), 12 episodes of gastrointestinal hemorrhage, 6 episodes of iliopsoas bleeding and 2 episodes of pulmonary hemorrhage. In the case of ICH, seizure is usual symptom. In the case of gastrointestinal bleeding, hematochezia is the common symptom. In the case of iliopsoas bleeding, lower extremity pain and edema, limitation of motion are common symptoms. CONCLUSION: In order to minimize complications, we must perform fast, accurate judgement and treatment when the patients with hemophilia visit ED.

Prophylactic Antibiotics Therapy after Splenectomy / 임상소아혈액종양

BACKGROUND: Patients who are born without spleen or who have impaired splenic function due to disease or splenectomy become vulnerable to sepsis caused by bacteria. Overwhelming post-splenectomy infection (OPSI) occurs at an estimated incidence of 0.23-0.42% per year with a lifetime risk of 5%. The risk of OPSI with encapsulated bacteria is generally considered greatest in the first 2 years after splenectomy but the increased risk remains lifelong. Because vaccination doesn't completely protect against infection with encapsulated bacteria that prevent OPSI, use of prophylactic antibiotics are recommended for prevention of infection after splenectomy. METHODS: A retrospective review of 41 patients who underwent splenectomy from January 1990 to December 2012 in Inje University Busan Paik Hospital were identified through the medical records. RESULTS: Of 41 patients, 100% (41/41) were vaccinated in pneumococcal vaccines, 27% (11/41) were vaccinated in HIB vaccines. Prophylactic antibiotics (penicillin G benzathine IM every 4 weeks) were prescribed in 73% (30/41) of patients. We could not find any septic events. CONCLUSION: Because of the high mortality, the fulminant course, and the refractoriness to common treatment of overwhelming infections caused by encapsulated bacteria, prevention through vaccination and antibiotic prophylaxis is the basis of the management of patients who have had splenectomy or have hyposplenism. Prophylactic antibiotics using Penicillin G benzathine every 4 weeks is effective for preventing septic events in splenectomized patients. But further improvement in coverage of recommended vaccines and continuous prophylactic antibiotics after splenectomy is needed to reduce the risk of serious infection.