Transfusions of granulocytes can be used as an adjunct therapy to antimicrobials in patients with infection and neutropenia or granulocyte dysfunction. However, there is a lack of strong clinical evidence to support the use of this treatment strategy, particularly in children. We retrospectively reviewed the medical records of children who received granulocytes at our institution from April 2009 to October 2012, with emphasis on primary indication for the transfusion and clinical outcome in terms of infection. The patients had granulocyte dysfunction or severe neutropenia, defined as absolute neutrophil count (ANC) < 500 cells/mm(3) due to chemotherapy or hematopoietic stem cell transplant (HSCT), and reasonable hope for bone marrow recovery or engraftment. Eighteen children received granulocytes during 20 distinct episodes: 62% (n = 13) for acute infection, 29% (n = 5) for unresolved chronic infection during the time of HSCT, and 9% (n = 2) for other clinical conditions such as typhilitis and appendectomy. Overall, 92% (n = 12) of the episodes of acute infection had complete or partial resolution, as determined by review of vital signs, physical exam findings and discontinuation of antimicrobials. A substantial number (46%) of children who received granulocytes for acute infection developed respiratory adverse events, but all of these recovered. We conclude that granulocyte transfusions continue to be primarily used in neutropenic patients with acute infections, and that its use in this group of patients is reasonable. However, a prospective randomized clinical trial is needed to evaluate safety and whether the use of granulocytes is superior to antimicrobial-only therapy.
BackgroundFresh frozen plasma transfusion is widely utilized in pediatric clinical practice to correct mild coagulopathy. Several studies on adult population have shown that transfusion of plasma cannot effectively correct mild coagulopathy when international normalized ratio (INR) is ≤1.5. Much controversy exists about the generalization of this finding for pediatric populations, especially since pediatric dosages often exceed those in adults. The aim of this study is to determine the prevalence of plasma transfusion with mild coagulopathy (INR ≤ 1.5) and its effectiveness in a pediatric setting.MethodsIn our tertiary referral hospital, we retrospectively reviewed the electronic medical records of all patients who received plasma (April to October 2011) for mildly elevated prothrombin time (PT)-INR levels (≤1.5) and had post-transfusion PT-INR measurements; patients who received intraoperative, ECMO, or plasma exchange-related plasma transfusions were excluded from this study. We abstracted demographic data and pre- and post coagulation test results for the patients included in our study.ResultsAmong 468 plasma transfusions administered to 285 patients from April to June 2011, 60 plasma transfusions (12.8%) were given to patients with PT-INR ≤ 1.5 (range 1.3–1.5). Forty-one patients [median age 2.5 years (IQR, 0.14 to 13.75 years), median weight of 16.0 kg (IQR, 8.0 to 69.3 kg)] who received 41 single plasma transfusions [median dose 11 mL/Kg (IQR, 6–15)] had post-transfusion PT-INR measurements and were included in our study. There was no significant difference in their PT-INR values (p = 0.34) pre- and post-transfusion. Of our study, only 15.4% patients showed post-transfusion normalization [median change in PT-INR 0.15 (IQR, 0.1–0.2)] and were not different from the remaining 85% in age, plasma dose, and bleeding status.ConclusionsThe prevalence of plasma transfusion for correction of mildly elevated PT-INR levels in critically ill children is high (12.8%). Plasma transfusion showed no significant effect in correcting minor prolongation of PT-INR in pediatric patients regardless of age, volume of plasma transfused per kilogram (dosage), or bleeding status.
3–10% of endometrial biopsies are said to show histologic evidence of chronic endometritis. In this study we correlate the # of plasma cells by H&E to the # of plasma cells by CD138 IHC in endometrial biopsies.Methods100 endometrial biopsies were selected, excluding specimens with limited material, cancer and menstrual phase. H&Es were reviewed, and the # of plasma cells/10 hpfs were recorded. Additional sections were stained with CD138 antibody (clone B‐A38; Cell Marque, Rocklin, CA). Hot spots of CD138+ cells were recorded as the #/10 hpfs. Histologic findings near the CD138+ cells were also recorded.ResultsPlasma cells were identified in 29 cases by H&E alone (ave. 2.1, range 1–12) and 90 cases were + for plasma cells by CD138 (ave. 13.9 plasma cells, range 1–190). Of the 29 cases with plasma cells on H&E, CD138 highlighted an average of 24.3, with a minimum of 1. 71 biopsies lacked plasma cells on initial H&E review, but averaged 7.7 plasma cells by CD138. Often, the endometrial stroma contains scattered lymphocytes or mild edema, but lacked the spindled stroma typically associated with chronic endometritis.ConclusionsBy careful exam on H&E, >1 plasma cells were seen in 29% vs. 90% of endometrial bxs by CD138. These cases include diagnoses of gland‐stromal dyssynchrony, disordered proliferative endometria, and endometrial hyperplasias. The presence of CD138+ plasma cells may not equate to chronic endometritis.
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