Hematological consequences of pandemic influenza H1N1 infection: a single center experience.

Since its identification in April 2009, pandemic influenza H1N1 virus has affected thousands of people worldwide. Viruses, particularly Epstein-Barr virus, cytomegalovirus and parvovirus B19, may have diverse hematological consequences, including anemia, neutropenia, thrombocytopenia, lymphocytosis, hemophagocytic lymphohistiocytosis, and coagulation abnormalities. In this study, a total of 31 consecutive pediatric patients, with and without chronic diseases, who had flu symptoms and were confirmed to have pandemic influenza, were evaluated for hematological consequences upon presentation to hospital. Eight (25.8%) patients had leukopenia and six (19.4%) had thrombocytopenia at the time of diagnosis of H1N1 infection. Pandemic influenza H1N1 infection may cause diverse hematological findings, including cytopenias and hemophagocytosis.

Parvovirus-B19 and hematologic disorders.

Parvovirus-B19 (PV-B19) is a member of Parvoviridae, which is one of the smallest DNA viruses. PV-B19-associated diseases usually serve as a good representation of the balance of virus, host response and the immune system. The diseases manifested with PV-B19 are erythema infectiosum, which is common in children, hydrops fetalis, transient pure red cell aplasia in patients with chronic hemolytic anemia, arthralgia - mostly observed in women, and chronic pure red cell aplasia in immunocompromised individuals. Cytopenia (bicytopenia, monocytopenia or pancytopenia) may also accompany the diseases mentioned above. On the other hand, there are many diseases, including neurologic, vasculitic, hepatic, rheumatoid, nephritic, autoimmune, myocardial, and others in which the mechanisms of the diseases are not clear, which may be associated with PV-B19. The virus may manifest with unexpected and unexplained clinical pictures and lead to misdiagnosis. Therefore, hematologic disorders in any unestablished clinical diagnosis should be investigated for PV-B19 infection. However, serologic examination for PV-B19 diagnosis is not sufficient in immunocompromised status. The virus can be determined with polymerase chain reaction (PCR) in the serum or tissue samples. Supportive therapy, blood transfusion and immunoglobulin are the conventional therapeutic interventions for PV-B19 today. Vaccination studies are under examination.

Early detection of pulmonary fungal infection by CT scan in pediatric ALL patients under chemotherapy or in post-transplantation period with primary complaint of chest pain.

We describe herein four children with acute lymphoblastic leukemia who were diagnosed as pulmonary fungal infection after presenting with chest pain. The plain radiologic evaluations failed to reveal any positive findings, whereas computerized tomography (CT) scanning showed nodular opacification with or without cavitation. This experience suggests that chest pain may be an initial symptom of an invasive fungal infection in patients with leukemia, and CT scan of the lungs should be performed urgently for the early diagnosis and treatment, despite normal plain X-rays.

Autoimmune hemolytic anemia and giant cell hepatitis: Report of three infants.

Giant cell hepatitis associated with direct Coombs' test-positive hemolytic anemia is a rare condition of childhood and the pathogenesis remains unclear. An autoimmune activation and loss of self-tolerance in these patients may be the underlying pathology related to the response of some of the patients to immunosuppressive treatment. Herein, we report the clinical presentation and course of three consecutive patients with this rare condition. We conclude that serum ferritin at diagnosis may be used for prediction of the outcome.

Weekly long-term intravenous immunoglobulin for refractory parvovirus B19 and Epstein-Barr virus-induced immune thrombocytopenic purpura.

In pediatric acute immune thrombocytopenic purpura (ITP) cases, it is usually possible to determine an underlying pathology; among them, viral infections are the leading causative agents. In this report, we describe two cases of acute ITP complicated secondary to parvovirus B19 or Epstein-Barr virus (EBV) infections who were unresponsive to initial therapeutic measures, but who responded to long-term intravenous immunoglobulin (IVIG) treatment, given weekly for five to eight weeks.