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Objective:To investigate the clinical characteristics, diagnosis and treatment of mycoplasma pneumoniae(MP) pneumonia in children with pseudo-macrocytic erythrocytes.Methods:The clinical data of 50 children with mycoplasma pneumoniae pneumonia with pseudo-macrocytic erythrocytes in the Department of Pediatrics at Shengjing Hospital of China Medical University from January 2019 to August 2020 were analyzed retrospectively.Results:Among the 50 cases, there were 32 boys and 18 girls.The blood routine examination showed that pseudo-macrocytic erythrocytes, red blood cells decreased significantly, mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration increased significantly, as well as MP-IgM was positive.Sixteen cases were complicated with herpes simplex virus infection, one with Epstein Barr virus infection, and six with both herpes simplex virus and Epstein Barr virus infection at the same time.All 50 cases were MP pneumonia, pulmonary imaging showed lobar pneumonia, and 25 cases were complicated with pleural effusion, including 32 cases of refractory MP pneumonia.The clinical symptoms of three cases were extrapulmonary manifestations, hemolytic anemia and diagnosed with cold agglutinin syndrome.In 36 children with D-dimer more than 252 μg/L, one case had femoral vein thrombosis and one case had pulmonary embolism.Conclusion:Pseudo-macrocytic phenomenon may play important roles in clinical etiological diagnosis, severity of disease and refractory MP pneumonia.The children with hemolytic anemia suggest cold agglutinin syndrome, and the hypercoagulable state of MP infection may be related to the aggregation of red blood cells caused by cold agglutinin in MP infection.
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The authors analyzed 140 cases of malignant lymphoma (ML) associated with autoimmune cytopenia (AIC), including autoimmune hemolytic anemia (AIHA), immune thrombocytopenia (ITP), pure red cell aplasia (PRCA), and Evans syndrome. The analysis was based on cases reported in the literature as well as the reference lists of papers in this field from 1989 to 2019 by Chinese scholars. The number of cases involving various non-Hodgkin's lymphoma subtypes was small (n=1-28). Nevertheless, interesting and sometimes unexpected differences were noted among different types of ML and AIC. All types of AIC except AIN were seen to coexist with ML, and the increasing order of incidence was as follows: warm antibody-AIHA >ITP >cold antibody-AIHA>PRCA>Evans syndrome. CAS was only seen with B-cell lymphomas, WA-AIHA, and ITP, Evans syndrome was more frequent in B-cell lymphomas and PRCA predominantly occurred with T-cell lymphomas. Anti-lymphoma treatment seemed to be more effective against AIC than conventional therapy with steroids or immunoglobulin. Although based on a literature survey, this compilation of data indicates a complex relation between lymphoma and AIC and warrants more attention and specific studies.