scholarly journals Pediatric Acute Promyelocytic Leukemia Presenting to the Emergency Department as Refusal to Ambulate

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Kevin R. Schwartz ◽  
Jennifer M. Hanson ◽  
Alison M. Friedmann
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Acute Promyelocytic Leukemia ◽  
Blood Smear ◽  
Brain Mri ◽  
Pediatric Intensive Care ◽  
Peripheral Blood Smear ◽  
Promyelocytic Leukemia ◽  
Severe Anemia ◽  
Intracranial Hemorrhages

A previously healthy 10-year-old girl presented to the emergency department (ED) with a headache and vomiting which resolved with oral NSAIDs. The patient returned two days later unable to ambulate with mental slowing and lower extremity bruising. Labs demonstrated marked leukocytosis, severe anemia and thrombocytopenia, and disseminated intravascular coagulation (DIC). Brain MRI showed multiple intracranial hemorrhages. A peripheral blood smear demonstrated blasts with many Auer rods. A diagnosis of acute promyelocytic leukemia (APL) was made and therapy including all-transretinoic acid (ATRA) was initiated. Neurologic status returned to baseline within 1 week in the pediatric intensive care unit.

scholarly journals Pediatric Acute Promyelocytic Leukemia

2021 ◽  
Vol 8 (11) ◽  
Author(s):  
Campos Davó E ◽  
◽  
Verdú Belmar J ◽  
Garzó Moreno A ◽  
de Paz Andrés F ◽  
...  
Keyword(s):  
Blood Smear ◽  
Peripheral Blood Smear ◽  
International Normalized Ratio ◽  
Skin Lesions ◽  
Pediatric Emergency ◽  
Promyelocytic Leukemia ◽  
Pediatric Emergency Department ◽  
Laboratory Results ◽  
Wbc Count

A previously healthy 4-year-old boy presented to the pediatric emergency department with high fever, headache, asthenia and neutropenia. The fever started two days prior along with the appearance of purple skin lesions. Laboratory results were as follows: White Blood Cell (WBC) count of 44.2 × 109 hemoglobin 62g/L; hematocrit 18.9%, platelet count 30 × 109/l, international normalized ratio (INR) 1.06, lactate dehydrogenase (LDH) 479u/l, creatinine 37μmol/l. Peripheral blood smear demonstrated: 80% of abnormal promyelocytes with bilobar nuclei and cytoplasmic granules; some contained multiple Auer rods. Immunophenotyping demonstrates CD13, CD33, CD117, and myeloperoxidase positivity with a high side-scatter. Fluorescence in situ hybridization revealed the t(15;17) (q22;q21.1) (PML-RARA) (Figure 1 and 2).

The Burden of Burnout Syndrome in Pediatric Intensive Care Unit and Pediatric Emergency Department

2019 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Mutlu Uysal Yazici ◽  
Ozlem Teksam ◽  
Hasan Agin ◽  
Nilgun Erkek ◽  
Ali Ertug Arslankoylu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Pediatric Emergency ◽  
Burnout Syndrome ◽  
Pediatric Emergency Department

Cold Agglutinin Syndrome in Post-Liver Transplant Patients on Tacrolimus.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 967-967
Author(s):  
Wendy Wong ◽  
Jason Merker ◽  
Christine Nguyen ◽  
William Berquist ◽  
Bertil Glader ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Hemolytic Anemia ◽  
Peripheral Blood ◽  
Blood Smear ◽  
Peripheral Blood Smear ◽  
Cold Agglutinin ◽  
Severe Anemia ◽  
Thermal Amplitude ◽  
Antiglobulin Test

Abstract Following liver transplantation, patients require immunosuppressive medications to prevent graft rejection. However, these drugs can have significant side effects including severe anemia. Tacrolimus is now commonly used in pediatrics patients after liver transplantation. Case reports indicate that tacrolimus rarely can cause microangiopathic hemolytic anemia and also hemolytic anemia due to cold reactive IgM antibodies (cold agglutinin disease). We have seen 4 patients with symptomatic cold agglutinins thought to have been triggered by tacrolimus. Four patients, 6 to 26 months post-ABO-compatible liver transplant, presented with severe anemia (hemoglobin < 6g/dL), indirect hyperbilirubinemia, reticulocytosis and low serum haptoglobin (Table 1). Peripheral blood smear exhibited marked autoagglutination but no evidence of microangiopathic changes. The direct antiglobulin test (DAT) initially was strongly positive in all 4 patients (Table 2). After warm saline washes, the DAT remained positive for complements in 3 out of 4 patients. Cold agglutinin titers were low (1:4 – 1:16) but thermal amplitude studies were positive at 37°C in the two tested patients. Viral serologies significant for cold agglutinin syndrome were negative. None of the patients had clinical evidence of post-transplant lymphoproliferative disorder. All 4 patients had brisk hemolysis requiring multiple uncrossmatched packed red blood cells (PRBC) transfusions. Favorable resolution of the hemolytic anemia occurred following steroids, plasmapheresis and withdrawal of tacrolimus. Subsequently, patients were placed on cyclosporin and none exhibited liver rejection or recurrence of their hemolytic anemia. The above observation indicates that acute cold-agglutinin induced hemolysis occurs in patients following liver transplantation and these events appear to have temporally associated with tacrolimus administration. Patient Profiles Patient Age Diagnosis Months after transplant Presenting hemoglobin (g/dL) Reticulocyte (%/Abs k/μL Total/Direct Bilirubin Treatments (in addition to withdrawal of tacrolimus) ND=not done. MP=methylprednisolone 1 8 mos Neonatal iron storage disease 6 2.8 41%/469 4.2/0.6 MP 4mg/kg/d plus
 30mg/kg/d x 3 days.
 Plasmapheresis x 6. 2 13 mos Biliary atresia Idiopathic 6 5.3 8%/250 3.2/0.4 MP 4mg/kg/d.
 Plasmapheresis x 15. 3 2 yrs 5 mos fulminant hepatic failure 14 4.6 19.5%/237 2.6/0.3 MP 10mg/kg/d.
 Plasmapheresis x 10. 4 4 yrs Biliary atresia 26 5.3 5%/ND 8.8/0.5 MP 2mg/kg/d→ 4mg/kg/d.
 Plasmapheresis x 10. Immunohematology Profiles Admission DAT Patient 1 Patient 2 Patient 3 Patient 4 Admission DAT Pre/post saline wash Pre/post saline wash Pre/post saline wash Pre/post saline wash DAT-Direct antiglobulin test, M-microscopically, NT-not tested, +-positive, 0-negative, Polyspecific 3+/0 1+/M+ 4+/4+ 3+/1+ Anti-IgG 2+/0 M+/0 4+/1+ 3+/1+ Anti-C3 2+/0 2+/1+ 4+/4+ 3+/1+ Saline Control 2+/0 1+/0 1+/0 1+/0 Eluate 0 NT Panreactive 1+ Panreactive 1+ Cold agglutinin titer at 4°C in saline NT 4 8 16 Thermal amplitude screen at 30°C NT NT Reactive Reactive Donath-Landsteiner Test NT NT Negative Negative Admission peripheral blood smear 4+ polychromatophilia. 4+ microcytosis 4+ autoagglutination. 3+ polychromatophilia. 3+ spherocytes. 3+ microcytes 3+ autoagglutination. 3+ polychromatophilia. 3+ spherocytes. 2+ macrocytes 4+ autoagglutination. 4+ spherocytes. 2+ polychromatophilia. 2+ macrocytes

The Resource Burden of Infections With Rhinovirus/Enterovirus, Influenza, and Respiratory Syncytial Virus in Children

2018 ◽  
Vol 58 (2) ◽  
pp. 177-184 ◽  
Author(s):  
Jenna Fine ◽  
Amelia Bray-Aschenbrenner ◽  
Howard Williams ◽  
Paula Buchanan ◽  
Jason Werner
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Respiratory Syncytial Virus ◽  
Pediatric Intensive Care Unit ◽  
Influenza A ◽  
Pediatric Intensive Care ◽  
Billing Data ◽  
Emergency Department Care ◽  
Syncytial Virus

We reviewed the resource utilization of patients with human rhinovirus/enterovirus (HRV/ENT), influenza A/B (FLU), or respiratory syncytial virus (RSV). A total of 2013 patients with nasopharyngeal swabs positive for HRV/ENT, RSV, or FLU were included. Records were reviewed for respiratory support, vascular access procedures, emergency department care only versus admission versus pediatric intensive care unit (PICU) care, antibiotics, length of stay, and billing data. Of the 2013 subjects, 1251 tested positive for HRV/ENT, 558 for RSV, and 204 for FLU. Fewer HRV/ENT patients were discharged from the emergency department ( P < .001); and they were more likely to be admitted to the pediatric intensive care unit ( P < .001). HRV/ENT and RSV patients were more likely to require invasive procedures ( P = .01). Median hospital costs for HRV/ENT patients were more than twice that of FLU patients ( P < .001). HRV/ENT infection in pediatric patients poses a significant resource and cost burden, even when compared with other organisms.

Description and Contribution of Brain Magnetic Resonance Imaging in Nontraumatic Critically Ill Children

2016 ◽  
Vol 31 (14) ◽  
pp. 1584-1590 ◽  
Author(s):  
Guillaume Mortamet ◽  
Manoelle Kossorotoff ◽  
Amandine Baptiste ◽  
Nathalie Boddaert ◽  
Martin Castelle ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Magnetic Resonance ◽  
Pediatric Intensive Care Unit ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Resonance Imaging

Background: The authors aimed to collect all brain magnetic resonance imaging (MRI) performed in critically ill children in the authors’ medical pediatric intensive care unit over a 2-year period (2012-2013) to (1) describe the findings and (2) assess its contribution on practical patient care. Methods: This is a single-center and retrospective study. All children without traumatic brain injury who underwent a brain MRI during pediatric intensive care unit stays were included. To assess the exam’s contribution, the patient’s medical condition at the time of the MRI exam was blindly and separately exposed to a pediatric neurologist and a pediatric intensivist. Results: During the study period, 87 patients (7.5%) underwent a brain MRI. Median age was 4 months and 13 children (14.9%) died in pediatric intensive care unit. The most common final diagnosis was postanoxic encephalopathy. Brain MRI was abnormal in 68 patients (78.2%). No serious adverse event occurred during the transport. The neurologist and the intensivist considered brain MRI as indicated during pediatric intensive care unit stay in 65 (74.7%) and 68 patients (78.2%). They deemed that brain MRI had a diagnostic contribution in 76 (87.4%) and 60 (69.0%) patients, respectively. A therapeutic change consecutive to MRI findings occurred in 19 patients (21.8%) and MRI results were associated with a decision to withdraw life-sustaining treatment in 21 patients (24.1%). Conclusion: Brain MRI is one component of neuromonitoring, and this study suggests a substantial diagnostic contribution, although its therapeutic impact appears limited to specific diagnoses.

scholarly journals Disseminated Intravascular Coagulation With Purpura Fulminans Presentation of Acute Promyelocytic Leukemia

2019 ◽  
Vol 3 (4) ◽  
pp. 446-448
Author(s):  
Douglas Ader ◽  
Muhammad Durrani ◽  
Eric Blazar
Keyword(s):  
Emergency Department ◽  
Acute Promyelocytic Leukemia ◽  
Disseminated Intravascular Coagulation ◽  
Early Recognition ◽  
Survival Rates ◽  
Purpura Fulminans ◽  
Promyelocytic Leukemia ◽  
Intravascular Coagulation ◽  
Remission Rates

A 47-year-old male presented to the emergency department with 12 hours of nausea, vomiting, abdominal pain, and a widespread skin eruption with mottled, irregular, purpuric lesions with subsequent rapid decompensation. Laboratory analysis revealed thrombocytopenia, bandemia, elevated metamyelocytes, abnormal coagulation panel, decreased fibrinogen, elevated fibrin split products, renal dysfunction, bacterial rods, dohle bodies, and toxic granulation. Acute promyelocytic leukemia (APML) was confirmed via bone marrow biopsy, flow cytometry, and fluorescence in situ hybridization analysis. Disseminated intravascular coagulation (DIC) may be the initial presentation of APML. When treated promptly, APML can achieve high remission rates; however, conditions such as DIC continue to increase mortality requiring early recognition to improve survival rates.

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