Hematological findings among Jordanian children with celiac disease at presentation: a retrospective analytical study

To describe the hematological findings among children with celiac disease on presentation. This is a retrospective review which was conducted in the Pediatric Gastroenterology Department at Queen Rania Al Abdullah Hospital for Children. The records of children with celiac disease were reviewed between January 2006 and December 2012. The age of children included in the study was less or equal to 14 years on diagnosis. Complete blood count, serum ferritin, folate, vitamin B12, prothrombin time, partial prothrombin time, international normalized ratio, and tissue glutaminase antibody [IgA and IgG] were performed for all patients prior to the diagnosis. Upper gastrointestinal endoscopy was performed for all children included in the study and multiple duodenal biopsies samples were obtained during the procedure for routine histological analysis. A total of 111 children were included in the study; 53 [47.7%] were males and 58 [52.3%] were females. The mean age at diagnosis was 9 years. All children had positive tissue glutaminase antibody IgA, IgG, or both. Eleven children had leukopenia, 13 had lymphopenia, two had neutropenia, while eight had eosinophilia. Thirty four [30.4%] children had anemia. Twenty eight [25.2%] children had serum ferritin less than 7ng/ml, 30 [27%] had serum folate less than 5ng/ml and 9 [8.1%] children had vitamin B12 less than 200 pg/ml. Seventeen [60.7%] children who had serum ferritin less than 7ng/ml had also low serum folate [p=0.001]. Four [36.4%] out of eleven children with leukopenia had serum folate below 5ng/dl [p=0.2]. Vitamin B12 level in children with absolute lymphocyte count less than 1500/microL was significantly less than that of children with equal or more than 1500/microL [P value 0.02]. Twelve [10.8%] children had thrombocytosis. The mean hemoglobin level and serum ferritin were significantly lower in children with thrombocytosis than those with normal platelets [p<0.01]Celiac disease is associated with a diversity of hematological findings that include leukopenia, lymphopenia, neutropenia, and eosinophilia, as well as anemia, thrombocytopenia and thrombocytosis

Vipoma: a case report of uncommon cause of chronic diarrhea

The great majority of diarrhea episodes last for less than one week; when diarrhea persists for more than 14 days, it is called persistent, intractable, or chronic diarrhea. We are reporting a case of Ganglioneuroblastoma in a 16 months old girl, who was referred to King Hussein Medical Center for further evaluation of chronic diarrhea. This rare tumor has a yearly occurrence of less than 5 per 1.000.000 children. The child was successfully treated surgically and with chemotherapy with subsidence of diarrhea

Wilson's disease among children at King Hussein Medical Center

To describe the demographic characteristics and clinical presentation of 37 patients with Wilson's disease followed up at the Pediatric Gastroenterology Clinic. A specially designed data collection form was used to collect the relevant data; Medical history and a thorough clinical examination for patients who were diagnosed with Wilson's disease during the period between February 2000 and October 2010 at King Hussein Medical Center, Amman, Jordan was done. Laboratory investigations include ceruloplasmin level, liver enzymes, albumin, prothrombin time, partial thromboplastin time, international normalized ratio, complete blood count, urine analysis, abdominal ultrasound and liver biopsy. Simple descriptive statistics [frequency and percentage] were used to describe the study variables. A total of 37 patients diagnosed as Wilson's disease with age ranges between two and 13.5 years were included in this descriptive review. Out of 37 patients, 19 [51%] were males and 18 [49%] were females. Patients with affected siblings were 29 [78%]. Central nervous system involvement was found among 9 [24.3%] patients. The commonest presenting symptoms were jaundice [n=16, 43%], abdominal distension [n=13, 35%], fatigue and delayed school performance [n=12, 32.4%]. The most common clinical findings were hepatomegaly [n=26, 70%], jaundice [n=16, 43%], splenomegaly [n=14, 37.8%], Kayser-Fleischer ring [n=11, 29.7%], and lower limb edema [n=11, 29.7%] respectively. Low ceruloplasmin level was found in 34 [92%] patients, high liver enzymes in 23 [62%] patients, hemolytic anemia in 13 [35%] patients successively. Twenty-four hour urine collection average copper post D-penicillamine challenging test was above 230 micro g/dl. The most common ultrasound findings were hepatomegaly, abnormal echogenecity, splenomegaly and ascitis. Liver biopsies commonly showed liver fibrosis, however fatty liver changes, hepatosteatosis and liver cirrhosis were the least common finding. Family screening is needed once a child in the family is diagnosed. Full investigations to rule out Wilson's disease should be performed in any patient with unexplained elevation of liver enzymes, hepatomegaly, hemolytic anemia, jaundice or neurological/behavioral disturbances

Ectopic spleen: a rare cause of abdominal pain

We report a five-year-old female, who presented to the pediatric clinic with chronic intermittent abdominal pain, and on physical examination, a large abdominal mass was felt in the right lower abdomen. Ectopic spleen was confirmed using abdominal ultrasonography, CT scan and isotope scanning. The patient underwent successful splenoplexy at King Hussein Medical Center