Case report: A case of immune thrombocytopenia combined with Hashimoto's thyroiditis and Helicobacter pylori infection in a child.

Immune thrombocytopenia (ITP) is one of the most prevalent acquired bleeding disorders in children, which is primarily characterized by a decrease in platelet count. It can be classified into two subtypes: primary ITP and secondary ITP. The underlying mechanisms causing ITP are complex and not fully comprehended. Helicobacter pylori (H. pylori) infections can lead to ITP and potentially trigger various autoimmune diseases. Furthermore, there is evidence of a correlation between thyroid disease and ITP. In this case report, we describe the case of an 11-year-old patient who presented with ITP, Hashimoto's thyroiditis (HT), and H. pylori infection. Following anti-H. pylori treatment and thyroxine supplementation, the child's platelet count increased compared to the previous count. The limitation of this report is that the platelet count of this child returned to normal after anti-H. pylori and thyroxine supplementation, so we cannot distinguish the effect of anti-H. pylori and thyroxine supplementation on the platelet count in this child. Despite this limitation, we still believe that early screening for thyroid function and H. pylori, as well as prompt eradication of H. pylori, along with thyroxine supplementation, may be beneficial in treating and improving the prognosis of children diagnosed with ITP.

Establishment of Review Criteria Coordinating With the Automated Digital Cell Morphology Identification System in a Specialized Women's and Children's Hospital.

OBJECTIVE: We aimed to establish appropriate review criteria for blood cell analysis in a specialized women's and children's hospital. Also, the CellaVision DI-60, was developed as one of the automated digital cell morphology analyzer, we evaluated if it was shown to be most effective under the certain review criteria. METHODS: A total of 2890 blood samples were detected to optimize the previously established review criteria for women and children with the Sysmex XE-2100. A total of 623 samples were used to validate the criteria. RESULTS: The microscopic-review rate based on the initial review criteria was 51.0%. After optimization, it was reduced to 17.3% and the false-negative rate was 3.85%. There was > 80% consistency between manual review results and CellaVision DI-60 preclassification when samples triggered the platelet- or red cell-related rules. The sensitivity for abnormalities (immature granulocytes, nucleated red blood cells) of reclassification was 90% to 100% and the false-negative rate was < 5%. However, direct microscopic review was required when the "Blasts/AbnLympho?" and "Atypical Lympho?" flags were triggered. CONCLUSION: Specialized review criteria are needed for women and children. An automated morphology identification system might help to improve the review criteria.

Facial paralysis as a presenting symptom of infant leukemia: A case report and literature review.

RATIONALE: Facial paralysis as the initial clinical presentation of infant leukemia (IL) is rare, and the rate of its misdiagnosis is high. Identifying the clinical characteristics of IL with facial paralysis as the initial symptom is necessary to improve the understanding of the causes of facial paralysis and IL. PATIENT CONCERNS: A 10-month-old infant had facial paralysis and recurrent fever. He was misdiagnosed as having bacterial meningitis for >2 months. DIAGNOSES: The infant was diagnosed as having acute monocytic leukemia (M5) with central infiltration based on examinations of the bone marrow and cerebrospinal fluid by flow cytometry. INTERVENTIONS: Before the diagnosis of leukemia, the patient was given meropenem, ceftriaxone, vancomycin, and ampicillin successively for anti-infective treatment for 2 months, and dexamethasone for several days. But he gave up further treatment after confirmed diagnosis. OUTCOMES: Our patient discontinued treatment and discharged. From literature review, there were 6 cases (including this case) of IL with facial paralysis as the initial symptom. 80% of patients were misdiagnosis and treated with a corticosteroid in the early stage, and the mortality was 33.3%. LESSONS: The clinical symptoms of IL with facial paralysis are not typical, with a high rate of misdiagnosis. When the cause of facial paralysis is unknown or the advance treatment effect is poor, tumor diseases should be considered. Corticosteroids should be carefully administered to children with facial paralysis.

No prognostic significance of immunophenotypic changes at the end of remission induction therapy in children with B-lineage acute lymphoblastic leukemia.

Detection of aberrant antigen expression in acute lymphoblastic leukemia (ALL) by flow cytometric is proposed for the quantification of minimal residual disease (MRD). There are few studies that investigate the stability of the antigen expression in children with B lineage ALL at the end of remission induction therapy and determine its prognostic impact. Between 2010 and 2015, 691 bone marrow specimens of childhood ALL were sent at diagnosis for immunophenotypic characterization, and follow-up samples for MRD were analyzed on day 33. Of these, 155 patients with MRD more than or equal to 0.01% were eligible for the study. Immunophenotypic studies were performed by multiparametric flow cytometry using four-colour monoclonal antibody combinations. Overall, 86 of 155 (55.5%) cases showed phenotype shifts at least one marker. CD19 was the most stable markers. By contrast, CD20 was significantly different between diagnosis and day 33 in nearly one third of the cases. Shifts of antigen expression was not significantly associated with EFS, RFS or OS (P > 0.05). Multivariate analysis showed that WBC and BCR-ABL have independent prognostic value in childhood ALL. Changes in antigen expressions were commonly occurred at the end of induction and not associated with prognostic value in patients whose MRD were positive on day 33.

Two cases of false platelet clumps flagged by the automated hematology analyzer Sysmex XE-2100.

BACKGROUND: Automated hematology analyzer is widely used by clinical laboratories to examine blood cell counts and differential leukocyte counts. However, a microscopic examination of a well-prepared blood film is still necessary and useful in most cases. METHODS: Two patients with severe disease were required complete blood counts (CBC) after admission at West China Second University Hospital in Southwest China. RESULTS: A false "platelet clumps?" flag was generated by the automated hematology analyzer Sysmex XE-2100. However, when the well-prepared blood film was reviewed, there was echinocytosis rather than clumps of platelets. In addition, both patients had severe metabolic acidosis with arterial blood pH <7.00 and HCO3- <4 mmol/l. On day 2 of admission, the false platelet clumps flags were not presented in both cases. CONCLUSIONS: Our further results suggested that the false platelet clumps had been flagged probably due to the influence of the extremely low blood pH. These two cases emphasized that a microscopic examination of a blood film was central to the morphology of blood cells. When the result of microscopic examination was abnormal, it was suggested that the physician should consider further testing to find underlying condition.