Immune thrombocytopenic purpura (ITP) is one of the most common hemorrhagic disorders in childhood. Platelet microparticles (PMPs) arise with platelet activation with procoagulant activity. Elevated PMP levels in adult ITP were reported to be thrombogenic in certain settings. However, their clinical significance in pediatric ITP was not studied. The aims of this study were to assess PMP levels in ITP in children and adolescents, and its correlation with clinical status and bleeding score. The study included 40 ITP patients (20 acute aged 9 +/- 2.19 years and 20 chronic aged 10.8 +/- 4.7 years) randomly selected from the Hematology Clinic, Children's Hospital, Ain Shams University, Cairo, Egypt, and 30 sex- and age-matched healthy controls aged 9 +/- 3.28 years. Patients were subjected to detailed history, assessment of bleeding score, complete hemogram, cytological bone marrow examination, and PMP quantification in peripheral blood by flow cytometry. Acute ITP patients had significant increase in PMPs, PMP/platelet count, and PMP percent compared to controls (P = .002, P < .0001, P < .0001, respectively) and compared to chronic ITP patients (P < .0001, P < .0001, P < .0001, respectively). PMPs were significantly decreased in chronic ITP patients compared to controls (P = .001), but PMP/platelet and PMP percent showed highly significant increase in chronic ITP (P < .0001). No correlation was evident between PMP levels and platelet count in either group (P > .05). Neither higher bleeding score nor thrombotic manifestations were observed in the studied ITP patients with high PMP levels. Elevated PMP levels may be protective against severe bleeding events in pediatric ITP. The role of PMP studies in deciding the management plan of childhood and adolescent ITP needs further evaluation.

BackgroundCarotid intima media thickness (CIMT) is a non invasive marker of subclinical atherosclerosis. Hyperglycemia, oxidatively modified atherogenic lipoproteins and advanced glycation end products are linked to increased oxidative stress in diabetes. We aimed to find out the relation between carotid intima media thickness in type 1 diabetic children and adolescents and plasma nitric oxide and total antioxidant capacity levels as markers of oxidative stress.MethodsThis study included 50 children and adolescents with type 1 diabetes mellitus with mean age (9.7 ± 3.4 years) and 50 healthy age and sex matched controls. They were subjected to assessment of hemoglobin A1c, total cholesterol and triglycerides, serum total antioxidant capacity, serum nitric oxide (NO) by colorimetric method and carotid intima media thickness by B-mode ultrasound.ResultsThere was significant elevation in serum nitric oxide (17.07 ± 6.4 vs 12.6 ± 4.7 μmol/L; p < 0.001), CIMT (0.47 ± 0.04 vs 0.39 ± 0.02 mm; p < 0.001) and significant reduction in serum total antioxidant capacity (0.41 ± 0.29 vs 0.87 ± 0.23 mmol/L; p < 0.001) in diabetic patients compared to controls. Carotid intima media thickness was correlated positively with nitric oxide (r = 0.402, p = 0.01) and negatively with total antioxidant capacity (r = -0.341, p = 0.02). Carotid intima media thickness was also correlated positively with age, duration of diabetes but not correlated with glycemic control or lipid profile.ConclusionThe significant elevation in nitric oxide and reduction in total antioxidant capacity in children and adolescents with type 1 diabetes mellitus with their correlation with carotid intima media thickness may reflect the role of oxidative stress in the development of atherosclerosis in young type 1 diabetic subjects.

Morphological differentiation between benign and malignant lymphoproliferative disorders (LPDs) can be challenging. Immunophenotyping (IPT) by either technique, flow cytometry or immunohistochemistry (IHC), is an important step in solving such difficulty. Thirty-five newly diagnosed patients with chronic B-cell neoplasms (11 chronic lymphocytic leukemia, 22 non Hodgkin lymphoma and 2 hairy cell leukemia) were included in this study with age range from 20 to 70 years. Monoclonal antibodies surface expression using lymphoproliferative disorders panel (CD45, CD19, CD5, CD10, CD11c, CD20, CD22, CD23, CD38, CD79b, FMC7, CD103, CD25, kappa and lambda light chains) by flow cytometry was done on bone marrow samples. CD20, CD5, CD23, Bcl-2, Bcl-6, kappa and lambda light chain immunostaining were performed on fixed bone marrow trephine biopsy specimen. The sensitivity of IHC was 81.8% in chronic lymphocytic leukemia (CLL) and 100% in non Hodgkin lymphoma (NHL) as regards CD20, 100% in both groups as regards CD5, 46% in CLL and 66.7% in NHL as regards CD23, 33.3% in CLL and 50% in NHL as regards kappa chain, 20% in CLL and 33.3% in NHL as regards lambda chain. We found that IHC and flow cytometry are equally effective in diagnosing CLL; however, IHC might be slightly more sensitive than flow cytometry in detecting bone marrow infiltration in NHL and hairy cell leukemia (HCL).

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