Study of some hemostatic factors in premature infants with respiratory distress syndrome [type I]

Respiratory distress syndrome [RDS] and its complications are responsible for a large percentage of neonatal morbidity and mortality. Hemostatic disturbances are frequently observed in sick preterm infants. Disseminated intravascular coagulation [DIC] usually follows the development of RDS or the establishment of severe sepsis. The aim of the present study was to identify the frequency of DIC and consumptive thrombocytopenia in premature infants with RDS, to assess the activity of the main natural inhibitors of coagulation [Antithrombin III [ATIII] and Protein C [PC]], and to correlate the clinical findings of possible relation to DIC with the laboratory markers of DIC in the investigated preterm infants. The study was conducted on 50 premature infants with RDS and 10 normal preterm infants as a control group. Infants were subjected to full monitoring of their clinical status, vital signs and blood gases. Coagulation study included measurement of prothrombin activity, activated partial thromboplastin time [APTT], serum fibrinogen, fibrin degradation products [FDPs], the activity of antithrombin Ill and protein C. Analysis of the results showed incomplete development of the coagulation system in preterm infants as indicated by decreased prothrombin activity %, the prolonged APTT, decreased ATIII and PC activity percentages. There was a significant reduction of platelet count, ATIII and PC activity % in the group of preterm infants with RDS. There was a significant correlation between the severity of RDS and the hemocoagulative parameters of DIC. Eight [16%] of the preterm infants with RDS had abnormal results suggestive of DIC. Six [12%] of our patients had compensated DIC and seven [14%] of them had consumptive thrombocytopenia

Conclusion: the results of this study highlighted the immaturity of the coagulation mechanism in Preterm infants. Consumptive thrombocytopenia and DIC are common complications of severe RDS

Varicella vaccine: a clinical and immunological study in healthy and immunocompromised children with acute lymphoblastic leukemia

The increased number and long term survival of immunocompromised children with acute lymphoblastic leukemia [ALL] might lead to their affection with fatal varicella, The objective of this study was to investigate the safety and immunogenicity of varicella vaccine in a group of children with ALL and non-immune siblings of leukemic children. Forty-five children with ALL and 26 healthy siblings of children with ALL all with negative history of chicken pox were immunized with live attenuated varicella vaccine [Oka strain]. At the time of the study, thirty-five were still receiving maintenance chemotherapy [group I] and 10 have completed their maintenance therapy [group II]. Group III included the 26 healthy siblings of children with ALL. The control group comprised 15 children with ALL who acquired natural varicella virus infection [group IV]. Serum IgG antibodies against varicella zoster virus [VZV] were measured by ELISA at baseline and at 3 and 6 months after vaccination for leukemic children and at baseline and 6 weeks after vaccination in healthy siblings, and once for the control group. The results showed that patients in groups II and III tolerated well the vaccine with no side effects. However, varicella form rash occurred in 5 [14%] children out of 35 cases of group I, Three of them were treated with oral acyclovir. Zoster occurred in 3 cases [8.5%] of group I. Seroconversion in 71.1% of children of group I and 70% of group II after one dose and in 91.4% of group I and 80% of group II after a second dose of the vaccine. The mean serum level of [VZV] IgG was significantly higher in groups III and IV than groups II and I after one dose of the vaccine [F=24.765, P<0.001]. The mean serum level of [VZV] IgG was significantly lower in ALL in children of group I after 6 months of vaccination compared to the healthy siblings [P<0.001]. However, during 3 years follow up; breakthrough varicella occurred in only one case of group II after household exposure. It was mild with no fever and with only 7 skin lesions

Conclusion: varicella vaccine administered carefully with close follow-up is safe and beneficial to leukemic children. The vaccine-induced immunity appeared effective in preventing or modifying chicken pox after exposure to natural disease in ALL children

Role of tissue factor pathway inhibitor [TFPI] As A predictor of disseminated intravascular coagulation [DIC] among children with sepsis syndrome

This prospective study aimed at evaluation of the role of tissue factor pathway inhibitor [TFPI] as a predictor of disseminated intravascular coagulation [DIC] among patients with sepsis who were admitted to the PlCU at Alexandria University Children's Hospital over a period of 15 month starting from September 2002. Study subjects comprised 20 children with suspected or. Pre-DIC, 10 children with overt DIC and 10 healthy children served as a control group. Both patients and control groups were evaluated for platelet count, prothrombin activity, aPTT, plasma fibrinogen, AT III %, FDPs, and TFPI. These hemostatic parameters were followed every other day for patients with pre-DIC, while performed once for overt DIC and control groups. Pre-DIC patients with good outcome showed increase in their prothrombin activity, AT III, fibrinogen; decrease in FDPs and slight decrease in aPTT. On the contrary, poor outcome was associated with further decrease in prothrombin activity, AT Ill, fibrinogen, and increase in FDPs, and slight decrease in aPTT. TFPI increased in both survivors and no survivors; however, the final figure was higher in the survivors. TFPI it] patients with overt DIC showed higher significant values in the survivors compared to no survivors

Conclusion: increased level of TFPI in DIC reflect the depletion of the endothelial cell bound TFPl pool with loss of endothelial protective effect. Its therapeutic use in sepsis is based on this concept; TFPI could be used in following the patients with DIC, however, its high cost limit ifs use as a prognostic parameter in DIC

Study of central nervous system involvement in children with acute leukemia in relation to different immunophenotypes before and during treatment

Central nervous system [CNS] involvement remains a problem in acute Ieukemias [AL] despite the fact that prophylaxis with intrathecal [IT], systemic high dose chemotherapy and radiotherapy have greatly reduced its incidence. The relationship between the immunophenotypes of AL and development of CNS disease is controversial. The present study included 40 children with newly diagnosed acute leukemia, 36 patients with ALL and 4 patients with AML. They were 23 males and 17 females. Their age ranged from 2-12 years with a mean age of 6.06 +/- 2.59 years. A panel of monoclonal antibodies were used for classifying the Ieukemias into different immunophenotypes. The most common immunophenotype of ALL cases [56%] was early pre-B [CD19, CD22 and CD10]. No CD10 [CALLA] negative cases were detected in our series. Two cases showed cytoplasmic immunoglobulin [Clg] indicating a more mature pre-B immunophenotype. T cell immunophenotype was detected in 14 cases mainly CD2, CD3 and CD7.AML immunophenotype was detected in 4 cases showing CD13 and CD33. Seven cases [17.5%] showed clinical symptoms and signs of CNS involvement at initial diagnosis whereas 8 cases [20%] showed blast cells in CSF. The majority [75%] of CNS disease cases [6 out of 8 cases] had a T cell immunophenotype, while 25% [2 out of 8 cases] were 8 cell lineage. The difference between the 2 groups was significant [P=<0.001]. During follow-up, 5 cases developed CNS relapse. Four of them [80%] were of T cell immunophenotype and only one case [20%] was of B cell lineage [pre 8 cell ALL]. Only one case of CNS relapse did not have CNS disease at initial diagnosis and was of T cell immunophenotype. Four of CNS relapse cases occurred early in the first year of the disease. In view of the poor prognosis of patients with CNS disease and relapse and the higher incidence of these events in T cell ALL children, these patients may need intensive systemic and CNS directed therapy to improve their outcome

Cerebrospinal fluid fibronectin versus thymidine kinase concentrations as predictors of CNS involvement in children with acute lymphoblastic leukemia

Acute Leukemias [AL] are the most common malignancy In childhood [33%] with acute Iymphoblestlc leukemia [ALL] constituting 75% of cases. Thirty years have elapsed since the first description of leukemic inhItration of central nervous system [CNS], however It still remains 8 problem In ALL. Fibronectin is a high molecular weight glycoprotein that Is detectable in the normal CSF at low concentration. Thymidine kinase is a cytoplasmIc scavenger enzyme present In dividing cells which converts thymidine Into thymidine monophosphate. It is usually undetectable In CSF of most normal individuals. We studied 20 newly diagnosed children with ALL [11 males and 9 females], none of them showed any evidence of CNS leukemia at diagnosis. Determination of thymidine kinase and Fibronectin concentrations In CSF of the studied cases was done at diagnosis. The studied children were followed up for an average of 2 years [range 1.6 - 25 years] after the start of Induction treatment. All of them echleved complete remission. During the treatment period 5 patients showed an evidence of CNS Involvement. The duration tiII CNS relapse ranged between 10 months and 12 months. Our results showed significantly higher Ievels of CSF thymidine kinase and fibronectin In patients who showed CNS disease men In those who had either remained on maintenance chemotherapy, completed the treatment or relapsed In other sites [R0. 0001 and P<.05 respectively]. Meningeal leukemia occurred In almost 70% of our patients [5 out of 7 patients] who showed CSF thymidine kinase values above the upper Limit of the normal range [1.4 U/microI.] recorded at diagnosis, while comparable levels were found In only 13% [2 out of 15 patients] without CNS relapse. Determination of levels of these markers [thymidine kinase and fibronectin] may be compiled with the more recent techniques that can Identify leukemic cells In CSF [as sensitive polymerase chain reaction assays] may help In prediction of patients with high risk of CNS relapse. These methods could be potentially useful in identifying sub-groups of ALL patients with no Initial CNS disease who require a more Intensive presymptanatic prophylactic CNS therapy