Metformin-induced hemolytic anemia

To report a rare side effect of metformin, an oral antidiabetic drug that is used for the treatment of type 2 diabetes mellitus. Clinical Presentation and Intervention: A 17-year-old boy was hospitalized for receiving acute lymphoblastic leukemia treatment that was composed of vincristine, L-asparaginase, daunorubicin, and prednisone. Hyperglycemia was determined without any clinical sign and metformin was started for steroid-induced insulin resistance. On the second day of metformin treatment, the patient's hemoglobin level decreased, and a direct Coombs test was positive for immunoglobulin G but negative for complement. An indirect Coombs test was negative. The glucose-6-phosphate dehydrogenase level was within the normal range. Drug-induced hemolytic anemia was suspected and metformin was discontinued. The jaundice gradually disappeared and there was no requirement for red blood cell transfusions. This case showed that physicians should be aware of the potential side effect of metformin although it is infrequent

Typhlitis in acute childhood leukemia

To review our experience with typhlitis among children treated for acute leukemia. Material and The medical records of children with acute leukemia and typhlitis between 2006 and 2009 were reviewed for demographics and symptoms, and for microbiological and imaging findings. In the 75 children with acute leukemia-54 with acute lymphoblastic leukemia [ALL] and 21 with acute myeloid leukemia [AML]-there were 10 episodes of typhlitis [4.5%] that developed during 221 periods of severe neutropenia. The cumulative risk of typhlitis was 7.4% in patients with ALL and 28.5% in patients with AML. Frequent symptoms were: abdominal pain and tenderness [100% each]; fever and nausea [90% each]; emesis [80%]; diarrhea [50%], and hypotension, peritonitis and abdominal distension [10% each]. The median duration of symptoms was 6 days [range: 2-11 days], and that of neutropenia 14 days [range: 3-25 days]. All patients were treated medically and none surgically. Two patients died because of typhlitis and sepsis. In our study, the rate of typhlitis among leukemic children was 4.5%; however, the mortality rate was 20%. Thus, rapid identification and timely, aggressive medical intervention are necessary to reduce the morbidity and mortality from typhlitis