Immunoglobulins and their use in children.

Immunoglobulin preparations are one of the products of the human plasma fractionation, where the plasma is obtained, in accordance with WHO guidelines from at least 1,000 donors. These preparations contain all IgG subclasses with various antigen characteristics. In clinical practice these drugs are used as replacement therapy in patients with primary and secondary immunodeficiencies as well as immunomodulatory therapy in many autoimmune diseases and systemic inflammatory diseases. Here we present characteristics of i.v. polyvalent, human immunoglobulin preparations available on the Polish market and the possibilities of their use in clinical practice, in children with hematological diseases. Considering the very low consumption of immunoglobulin preparations in our country as compared to other European countries, we would like to draw the attention of medical professionals, especially pediatricians and haematologists, to the benefits that stem from the use of these drugs in the therapy of children with haematological diseases. Our work will also facilitate the choice of an optimal polyvalent human immunoglobulin preparation for a particular patient.

Identification and characterization of acute infection with parvovirus B19 genotype 2 in immunocompromised patients in Poland.

Parvovirus B19 (B19V) is divided into three genotypes. Genotypes 2 and 3 may cause diagnostic difficulties and their epidemiology is not well understood. In the present study the prevalence of B19V genotypes in patients with symptomatic infection in Poland was evaluated and the course of infection in patients infected with non-genotype 1 strains is described. Real-time PCR, able to detect all three genotypes of B19V was used to screen patient plasma samples. Sixty-nine, mainly acute-phase B19V DNA positive cases were identified in patients from hematological and obstetric/gynecological wards between 2004 and 2008. Thirty patients were studied in greater detail and genotyping was performed by analysis of the NS1/VP1u region. The majority of samples were genotype 1. However two (6.6%) strains were identified as genotype 2, associated with high viremia and identified in a kidney transplant recipient with anemia and a leukemia patient, following chemotherapy, with pancytopenia. A change of immunosuppression treatment in the former and treatment with intravenous immunoglobulin in latter, resulted in normalization of clinical parameters, and whilst viral loads fell, B19V DNA was still detectable. The kidney transplant recipient subsequently became pregnant with no clinical complications, although persistently infected with B19V genotype 2. This is the first description of symptomatic cases of genotype 2 B19V infection in Eastern Europe suggesting that acute infection, particularly among immunocompromised patients with these virus strains may be more prevalent than thought.

[Erythropoietin treatment of infants with anaemia in the first three months of life]. / Leczenie erytropoetyna niemowlat z niedokrwistoscia pierwszego kwartalu zycia.

UNLABELLED: Synthesis of recombinant human erythropoietin opened new possibilities for treatment of anaemia in infants. AIM: To assess the safety and effects of this treatment of anaemia in infants. MATERIAL AND METHODS: The study included 111 infants with anaemia aged between 3 and 10 weeks. Children were referred to the One Day Clinic of the Department of Paediatrics, Haematology and Oncology, Warsaw Medical University, by family doctors because of low haemoglobin concentration, in spite of iron supplementation. Patients were divided into two groups: group A - term infants and B - preterm infants. Both these groups were divided according to risk factors: serological incompatibility and infection at birth or just after birth. Recombinant human erythropoietin was given subcutaneously in doses of 500 IU/kg b. w./week. Therapy was ended when haemoglobin concentration reached 11 g/dl. RESULTS: Initial haemoglobin concentration in serum is the main factor which influence the length of recombinant human erythropoietin therapy of anaemia both in preterm and term infants. Serological incompatibility and infection at birth and just after birth lengthen the period of erythropoietin treatment of anaemia in both groups of patients. CONCLUSIONS: Recombinant human erythropoietin is an effective and fully safe drug in the treatment of anaemia in the first three months of life, both in preterm and term infants. Its high effectiveness is confirmed by comparative analysis of haematologic parameters in the first trimester of retrospective control group of infants without recombinant human erythropoietin therapy and term infants who had been treated with erythropoietin.

[Danazol - effective second line therapy in idiopathic thrombocytopenic purpura in children. Three case reports]. / Danazol-skutecny lek drugiego rzutu w idiopatycznej plamicy maloplytkowej u dzieci. Opis 3 przypadkow.

Danazol is an accredited second line drug for idiopathic thrombocytopenic purpura (ITP) in adults. There are very few positions in the literature about using danazol in children, although some articles quote its evident efficacy. In this paper we present three cases of children treated with danazol. The routine treatment in these ITP cases was ineffective. The result was stabilization of platelet count and avoidance of splenectomy.