Iron Overload in Children with Leukemia Receiving Multiple Blood Transfusions

Objective: To find out prevalence of iron overload in children with leukemia at the end oftreatment, and to identify factors affecting iron overload. Methods: Children (age-1-14 y)treated for Leukemia of our center who completed treatment between January and August2016 were included in the study. Serum ferritin and iron were measured at completion oftreatment and total blood transfusion received throughout treatment was quantified. Serumferritin >1000 ng/mL was considered as marker of transfusional iron overload. Results: Outof 66 participants, 55 (83.3%) received red cell transfusions. Average transfused volumewas 48 mL/kg, and patients with high-risk leukemia received more transfusions thanstandard-risk patients. 16 patients (24.2%) demonstrated transfusional iron overload. Totaltransfused volume and treatment intensity were significant factors associated with ironoverload, and total transfused volume of >100 mL/kg (approximately 10 transfusions) wasthe most important determinant of transfusional iron burden. Conclusion: One-fourth ofpediatric leukemia patients demonstrated iron overload at the end of treatment. Thesepatients need to be monitored and followed-up after treatment to assess need for laterchelation therapy.

Low‑grade papillary adenocarcinoma of nasopharynx with expression of thyroid transcription factor‑1: Case report and review of literature.

Low‑grade papillary adenocarcinomas with expression of thyroid transcription factor‑1 (TTF‑1) are rare tumors of the nasopharynx, with only a few cases reported in the literature. These tumors have an excellent prognosis following complete surgical excision. We report a 13‑year‑old boy with this rare tumor in the nasopharynx. The patient underwent complete surgical excision of the tumor and was on follow‑up without evidence of recurrence.

Guillain-Barré Syndrome with Acute Lymphoblastic Leukemia.

Guillain-Barré syndrome (GBS) is rarely reported in children with acute lymphoblastic leukemia and may be difficult to differentiate from vincristine induced neuropathy. We report two children with acute lymphoblastic leukemia on induction chemotherapy who developed GBS. The diagnostic issues and potential pathogenic mechanisms underlying GBS in pediatric patients with ALL are discussed.

Acute Myeloid Leukemia Presenting as Obstructive Jaundice.

Jaundice as a presenting feature of pediatric acute myeloid leukemia is rare. We report two cases of AML who presented with obstructive jaundice, one with a malignant stricture at the common bile duct and other with a granulocytic sarcoma obstructing the bile duct. The prognosis is poor in these patients.