Relationship between nutritional status and treatment-related neutropenia in children with nephroblastoma

Background: Assessment of nutritional status of paediatric oncology patients is crucial, as it may influence treatment and clinical outcomes. Concurrent malnutrition and cancer in children may lead to reduced chemotherapy delivery due to impaired tolerance and increased toxicity.Aim: This study aimed to determine the relationship between nutritional status and the prevalence, frequency and duration of treatment-related neutropenia in a cohort of South African children with nephroblastoma.Methods: Seventy-seven children between the ages of 1 and 12 years diagnosed with nephroblastoma at Inkosi Albert Luthuli Central Hospital (IALCH), Durban, between 2004 and 2012, were studied prospectively. Nutritional status was assessed using weight, height, mid-upper arm circumference (MUAC), triceps skinfold thickness (TSFT) and serum albumin. The administration of filgastrim (Neupogen®) was used as a surrogate for neutropenia and the frequency and duration of its use was recorded.Results: There was a significant relationship between the prevalence of treatment-induced neutropenia and malnutrition defined by MUAC. The mean frequency and duration of neutropenia was significantly higher in those classified as malnourished using MUAC. There was a positive correlation between frequency and duration of neutropenia.Conclusions: Malnutrition was prevalent among children with nephroblastoma. The prevalence of treatment-induced neutropenia was higher in those with poor nutritional status, identified by MUAC. Poor nutritional status according to MUAC was also linked to an increased frequency and duration of neutropenia. It is important to include MUAC in the nutritional assessment of children with nephroblastoma

The prevalence of HIV seropositivity and associated cytopenias in full blood counts processed at an academic laboratory in Soweto, South Africa

Background. The HIV epidemic in South Africa (SA) has had a substantial impact on laboratory services, at least partially owing to the well-described propensity to cytopenias in HIV-positive patients.Objectives. (i) To formally gauge the impact of HIV infection on the state sector haematology services in SA by determining the HIV seropositivity rate among full blood counts (FBCs) performed at a large academic state sector laboratory; and (ii) to document the prevalence of cytopenias among HIV-positive patients in this setting.Methods. Randomly selected FBCs submitted to the National Health Laboratory Service laboratory at Chris Hani Baragwanath Academic Hospital, Johannesburg, were extracted from the laboratory information system (LIS) and retrospectively reviewed. HIV test results and other pertinent information in the LIS were documented, as was the presence of any cytopenias.Results. HIV status was documented in 561 of 1 006 samples (55.8%), with 307 (54.7%) of these being HIV-positive. Of the HIV-positive patients, 63.2% had one or more cytopenia/s. Anaemia was present in 183/307 (59.6%) of the HIV-positive patients, and was severe (haemoglobin <8 g/dL) in 32/307 (10.4%). Multivariate linear regression analysis showed significant independent associations between the presence of anaemia and both immunological AIDS (iAIDS) (p<0.0001) and male sex (p<0.025), but not HIV viral load (VL) (p=0.33) or antiretroviral therapy (ART) exposure (p=0.70). Thrombocytopenia and neutropenia were present in 37/307 (12.1%) and 11/51 (21.6%) of the HIV-positive patients, respectively, with no statistically significant association between either of these cytopenias and iAIDS, exposure to ART or VL.Conclusions. The findings reflect the substantial impact of the HIV epidemic on state sector laboratory resources, particularly the haematology service

Management of Febrile Neutropenia in Patients Receiving Chemotherapy for Solid Tumors: a Retrospective Study of Twenty Cases from the Radiotherapy Centre; Accra; Ghana

BACKGROUND: One in ten patients on anticancer medication will develop febrile neutropenia irrespective of tumour type. There is need to protect our patients from this fatal condition while optimising chemotherapy. This may be difficult for a poor country. OBJECTIVE: To assess the management of cancer patients with febrile neutropenia in a low resource setting. METHODS: Records of 20 cancer patients with febrile neutropenia (FN) over a three-year period were retrospectively analysed. Data retrieved included age; sex; type of cancer and number of cycles of chemotherapy taken. Other parameters included initial temperature; site of infection; absolute neutrophil count (ANC) at presentation and antibiotic choice. Use of antifungal drugs; duration of fever and overall treatment outcome were also assessed. RESULTS: The male : female ratio was 3:2 with a median age of 24 years (range: 15 - 68 years); and a mean temperature of 38.8 oC (range 38.0-39.8 0C). Mean absolute neutrophil count was 0.2 x 109 (range: 0.0 to 0.6 x 109). Thirteen (65) received Cisplatin; five (25) received Adriamycin; two (10) received Paclitaxel or Cyclophosphomide-Methotrexate-5; Fluorouracil (CMF). Ten(50) developed FN with the first cycle of chemotherapy; and six(30) in the second cycle. Twelve (60) had oral infection; four(20) had gastroenteritis and single episodes of respiratory and urinary tract infections. Eleven (55); received Ceftriaxone and Gentamycin; five (25) cases received Levofloxacin or ciprofloxacin and Amoxicillin/clavunate + metronidazole; two cases(10); Ceftazidime and Gentamycin; two cases(10) received Meropenem. Twelve (60) patients had antifungal therapy for oral candidiassis. Eight (40) patients received growth factors. The mean fever duration was 4.5 days (range 1-10 days). Two (10) of the patients died. CONCLUSION: Febrile neutropenia in resource limited countries can be managed with good history and physical examination skills. Aminoglycosides are important components of empiric treatment in Ghana

The Antibiotic Susceptibility of Bacteria Isolated from Blood Cultures during Episodes of Neutropenic Fever in Patients with Acute Myeloid Leukaemia

Neutropenic fever (NF) is a common and life-threatening complication of high-dose chemotherapy in patients with acute myeloid leukaemia (AML). Induction chemotherapy may result in complete remission in approximately 50-70of AML patients but is associated with an increased risk of infection due to immune suppression by the disease itself or as a result of treatment. Chemotherapy causes neutropenia as well as defective chemotaxis and phagocytosis. Chemotherapy-induced mucositis often occurs throughout the gastrointestinal tract; facilitating spread of endogenous flora to the blood circulation; leading to NF. The aim of this study was to determine the spectrum of bacteraemic microorganisms isolated during episodes of NF (NFEs) in AML patients in the Haematology Unit of the Universitas Academic Complex (UAC); as well as antibiotic susceptibility profiles of these organisms. Duration of NF; the time-span between chemotherapy and onset of NF; and the efficacy of antibiotics administered to patients; were also investigated

Profound Haemaological Changes In Rats Fed On Different Diet Formulae: A club To The Basis of Ethnic Leuko-Neutropenia

Persons of African origin reportedly have benign Leuko-neutropenia. This relative roles of vitamin B complex an proteins on the leucocyte counts and distribution in an animal model was investigated inbred adult male and female albino rats weighing between 100-160g (n=50) were randomised into four groups. At the end of six weeks feeding period; blood samples were obtained and total leukocyte count was done. The results of total court show that animals fed in protein supplemented diet had a profound increase in their leukocyte court when compered with the control. The study shows that specific dietary elements can induce profound charges n total and diferential leukocyte count