Hematologic Manifestations of Brucellosis in Children.

BACKGROUND: Brucellosis is a common zoonosis in the Bedouin population of southern Israel. Limited data exist for the rate and risk factors of hematologic complication of brucellosis in children. We assessed anemia, leukopenia, thrombocytopenia and pancytopenia in childhood brucellosis in southern Israel. METHODS: Our medical center is the sole hospital in southern Israel. All medical files of brucellosis, 2005-2014, identified through positive blood cultures or International Classification of Diseases 9th revision coding with positive serology, were reviewed retrospectively. RESULTS: Overall, 511 brucellosis episodes were identified; 42% (N = 214) with ≥1 cytopenia, including 13% (N = 68) anemia, 28% (N = 144) leukopenia, 14% (N = 74) thrombocytopenia and 2% (N = 9) pancytopenia. Overall, 99.8% of episodes were in Bedouin children and 70% in males. In 79% of episodes, blood culture was positive for Brucella melitensis. Acute infections comprised 84% of all episodes. In univariate analysis, older age (10.49 ± 4.81 vs. 9.25 ± 4.89 years), fever (92% vs. 78%), positive blood culture (84% vs. 75%) and IgM ≥1:640 levels (50% vs. 39%) were associated with cytopenia. In contrast, arthralgia was associated with noncytopenic episodes. In multivariate analyses, older age (odds ratio = 1.063) and fever (odds ratio = 3.127) were associated with cytopenia. CONCLUSIONS: Brucellosis is commonly presented with cytopenia, especially in bacteremic episodes with fever. However, pancytopenia is uncommon and its finding should alert the physician to look for other possible etiologies.

A comparative analysis of clinical characteristics of patients with paroxysmal nocturnal hemoglobinuria between Asia and Europe/America.

To accurately analyze the clinical characteristics of paroxysmal nocturnal hemoglobinuria (PNH) in different ethnic backgrounds, we retrieved all retrospective studies on clinical characteristics of PNH with a median follow-up period >60 months published after 2000, analyzed the clinical characteristics of PNH patients in Asia and European/America, and statistically compared enumeration data in these studies. We included 1665 patients in this analysis. The proportion of female patients in Asia was significantly lower than that in Europe/America (P = 0.000). Incidence rates of hemoglobinuria and thromboembolism in Asia were significantly lower than in Europe/America (both P values were 0.000). Within the subgroups of patients with thromboembolism, Asian patients had a higher proportion of arterial thrombosis while Western patients had a higher proportion of abdominal venous thrombosis. Bone marrow failure was not clearly defined in most studies. The proportion of patients with pancytopenia was higher in China than in France (P = 0.048). The total death rates were similar in both ethnic groups (P > 0.05). In Europe/America the major cause of death was thromboembolism and in Asian countries was serious infections. Differences in population characteristics of PNH patients among different ethnic groups indicate the possibility of differential pathogenesis and may be informative for treatment decisions.

Profile of HIV-Infected Hispanics with Pancytopenia.

Pancytopenia is seen in late HIV infection; it is associated with medical complications and with decreased survival. We determined the prevalence of pancytopenia at baseline in a cohort of HIV-positive Hispanics living in Puerto Rico, and compared their socio-demographic, immunological and clinical characteristics. A total of 1202 patients enrolled between 2000 and 2010 were included. They were grouped according to pancytopenia status, defined by having: platelets <150,000 µL, white cell count <4000 µL, and hemoglobin <12 g/dL (women) or <13 g/dL (men). Differences were evaluated using Student's t-test, Chi-square test and Kaplan-Meier method. The prevalence of pancytopenia was 8.7%. Patients with pancytopenia had lower BMI and lower CD4 count, as well as higher HIV viral load and higher proportions of unemployment, clinical AIDS and antiretroviral treatment (ART) use (p < 0.05). One-year mortality rate was significantly higher in patients with pancytopenia (18.1% vs. 5.1%, p < 0.001). When stratifying for ART this association persisted for patients who did not receive ART (41.4% vs. 5.2%, p < 0.001), but it was not seen in patients who received treatment (9.2% vs. 5.6%, p = 0.196). Pancytopenia was associated with elements of advanced stages of HIV. ART could reduce the mortality of HIV-patients with pancytopenia to levels comparable to patients without the disorders.

Pancytopenia in two national ethnic groups of Baluchistan.

BACKGROUND: Pancytopenia is a recognisable haematological problem with common categorises diagnosis but best possible diagnostic approach is still to be defined. OBJECTIVE: The aim of this study was to determine the frequent causes and clinical presentation of pancytopenia in relation to age and sex in different ethnic groups of two national (Pakistani and Afghan) living in Baluchistan province. METHODS: This is a cross sectional descriptive type of study was carried out on patients (n = 180) for two years (July 2009-June 2011). Cases were successively registered in 2 provincial government hospital and 2 private clinics in Quetta with diagnosis of pancytopenia. RESULTS: The most frequent causes of pancytopenia in both national ethnic groups were malaria (29.44%) fallowed by tuberculosis (17.22%), leukaemia (16.67%), aplastic anaemia (13.33%), hepatitis (12.22%), other diseases (7.22%) and iron deficiency anaemia (3.89%). Overall, 63.89% male subjects were observed pancytopenia as compared to 36.11% female patients. The results also showed that patients with age > 41 years were highly (50%) affected by pancytopenia followed by 21-40 years (30.66%) and < 20 years (19.44%). Moreover, leukaemia cases were observed significantly higher in Afghan subjects (> 41 years). The most common symptom of patients was (71.11%) fever followed by Pallor (42.22%), fatigue (38.33%), weight loss (26.11%) and dizziness (25.56%). Leukaemia and aplastic anaemia were found to be the most serious causes of pancytopenia in Afghan ethnic group. CONCLUSIONS: Malaria, tuberculosis, aplastic anaemia, and leukaemia were the leading causes of pancytopenia in Pakistani and Afghan ethnic groups. Severe pancytopenia has significant relation with the clinical conclusion and can be used as a prognostic marker.