Academic literature on the topic 'Neutropeni'

Latar belakang. Leukemia limfoblastik akut (LLA) merupakan keganasan yang sering ditemukan pada anak dan remaja. Demam neutropeni (DN) merupakan kedaruratan medik pada LLA yang sering menyebabkan kematian.Tujuan. Mengetahui angka kejadian dan kematian DN pada LLA anak selama terapi fase induksi.Metode. Penelitian deskriptif dengan disain potong lintang. Subjek adalah pasien LLA anak pada kurun Januari 2013 hingga Desember 2015, usia 1 bulan hingga 18 tahun dan tengah menjalani terapi fase induksi. Neutropeni ditegakkan dengan jumlah neutrofil absolut <1.500/mmk. Pengambilan sampel dilakukan secara consecutive sampling.Hasil. Terdapat 246 kasus LLA baru pada kurun waktu penelitian, 115 (46,7%) mengalami DN selama fase induksi. Kematian terjadi pada 15/115 (13%) kasus, 9/15 (60%) berhubungan dengan DN (sepsis, syok sepsis), sisanya karena sebab lainnya (sindrom lisis tumor, herniasi dan infiltrasi mening). Analisis pada kasus yang rekam mediknya selama fase induksi lengkap (59/115 atau 51,3%) menunjukkan 50/59 (84%) subjek mengalami satu kali kejadian DN, sisanya 9/59 (16%) mengalaminya 2-3 kali. Median terjadinya DN kali pertama setelah diagnosis adalah 8 hari (0-62 hari). Median durasi DN 7 hari (3-23).Kesimpulan. Kejadian demam neutropeni selama fase induksi masih tinggi dan merupakan penyebab kematian yang paling utama.

Neutropenic enterocolitis is a syndrome characterized by fever and abdominal pain in a neutropenic patient. It is often reported in children treated for leukemia and rarely reported in patients with other diseases. Herein, we report the case of a 9-year-old patient with a medical history of recurrent fever and mouth ulcers since the age of 4, who presented with neutropenic enterocolitis complicated with intestinal perforation which all leaded to disclose cyclic neutropenia. The patient was successfully treated by aggressive supportive care combined with surgical intervention. Neutropenic enterocolitis with possible complications should be considered and promptly managed in every neutropenic patient and may reveal a rare cause of neutropenia as cyclic neutropenia.

PURPOSE: Functional polymorphisms of the UGT1A1 gene, particularly the UGT1A1*28 variant, are associated with the severity of the bone marrow suppression in patients with metastatic colorectal cancer receiving irinotecan. This study assesses the cost-effectiveness of screening for UGT1A1*28 polymorphism associated with primary prophylactic Granulocytes Colony Stimulating Factor in patients homozygous for the *28 allele. The effectiveness was estimated based on the number of neutropenia avoided. METHODS: We modelled a theoretical population treated with combined 5-fluorouracil, leucovorin and irinotecan (FOLFIRI) for metastatic colorectal cancer. A decision tree simulated the health outcomes, measured by the prevalence of neutropenic events for two strategies, with or without UGT1A1 genotype screening. The model incorporated direct hospital costs and was validated with a sensitivity analysis. We calculated the cost-effectiveness ratio: CE=∆C / ∆E = "genotyping" cost – "no genotyping" cost / number of febrile neutropenia avoided. RESULTS: In the "genotyping strategy", the cost to avoid one febrile neutropenia event per 1000 patients treated was € 942.8 to € 1090.1. The sensitivity analysis showed a better CE ratio of € 733.4 to € 726.6 per febrile neutropenic event avoided.CONCLUSIONS: UGT1A1 genotype screening before irinotecan treatment is a cost-efficient strategy for the hospital. Systematic genotyping prior to chemotherapy, and administration of CSF in patients homozygotes for the *28 allele allow to avoid 91 febrile neutropenias at an acceptable cost.

AbstractObjective:To determine whether footwear exchange affects the incidence of febrile neutropenia among patients undergoing chemotherapy for hematologic malignancies.Design:Open trial with historical comparison.Setting:The 12-bed high-efficiency particulate air-fil-tered hematology unit at Osaka University Hospital, Suita, Japan.Patients:Those with hematologic malignancies who underwent chemotherapy from January 1997 through January 2003. Footwear exchange was discontinued in January 2000.Methods:The surveillance system was based on the National Nosocomial Infections Surveillance System of the Centers for Disease Control and Prevention. Rates of febrile neutropenia were calculated for neutropenic patient-days (ie, days with neutropenia < 500/μL).Results:From January 1997 through December 1999 and from February 2000 through January 2003, 58 and 54 patients endured 237 and 184 neutropenic periods following chemotherapy, and their total neutropenic days were 3,123 and 2,503, respectively. They showed episodes of febrile neutropenia 89 and 68 times, respectively. Infection rates were 28.5 and 27.2 per 1,000 neutropenic patient-days (P = .83), respectively.Conclusion:The incidence of febrile neutropenia was not affected by footwear exchange. In hematology units, changing shoes does not appear to affect the rate of infections during neutropenic periods.

Abstract Background In some neutropenic cancer patients fever may be absent despite microbiologically and/or clinically confirmed infection. We hypothesized that afebrile neutropenic cancer patients with severe infections have worse outcome as compared to cancer patients with febrile neutropenia. Patients and methods We retrospectively analyzed all adult cancer patients with chemotherapy-induced neutropenia and severe infection, who were admitted to the Intensive Care Unit at our cancer center between 2000 and 2011. The outcome of interest was 30-day in-hospital mortality rate. Association between the febrile status and in-hospital mortality rate was evaluated by the Fisher’s exact test. Results We identified 69 episodes of severe neutropenic infections in 65 cancer patients. Among these, 9 (13%) episodes were afebrile. Patients with afebrile neutropenic infection presented with hypotension, severe fatigue with inappetence, shaking chills, altered mental state or cough and all of them eventually deteriorated to severe sepsis or septic shock. Overall 30-day in-hospital mortality rate was 55.1%. Patients with afebrile neutropenic infection had a trend for a higher 30-day in-hospital mortality rate as compared to patients with febrile neutropenic infection (78% vs. 52%, p = 0.17). Conclusions Afebrile cancer patients with chemotherapy-induced neutropenia and severe infections might have worse outcome as compared to cancer patients with febrile neutropenia. Patients should be informed that severe neutropenic infection without fever can occasionally occur during cancer treatment with chemotherapy.

Latar belakang. Resistensi antibiotik saat ini menjadi problem dunia yang mencemaskan.Penggunaan antibotik secara berlebihan dan tidak rasional merupakan kontributor utamaterjadinya resistensi antibiotik. Upaya mengubah pola peresepan antibiotik menjadi lebihrasional merupakan hal yang tidak mudah.Tujuan. Memperbaiki kuantitas dan kualitas penggunaan antibiotik pada pasien yangdirawat dengan demam, serta mengevaluasi dampak terhadap morbiditas dan mortalitas.Metoda. Penelitian prospektif intervensi di bangsal anak RS Dr Kariadi, Juli 2003 -Desember 2004, dibagi menjadi 4 periode yaitu periode awal, penyusunan pedoman,pelatihan, dan umpan balik. Pada periode awal dilakukan pengambilan data dasar. Padaperiode penyusunan pedoman dilakukan konsensus untuk menyusun pedoman penggunaanantibiotik pada anak dengan demam. Periode pelatihan adalah sosialisasi dan pelatihankepada dokter. Pada periode pascapelatihan dilakukan umpan balik terhadap pesertapelatihan. Subyek penelitian adalah semua pasien usia >1 bulan yang dirawat dengandemam> 38ºC (rektal) dalam 24 jam pertama perawatan, kecuali yang diketahui menderitaHIV/AIDS atau neutropeni karena kemoterapi. Data penggunaan antibiotik diambil daricatatan medik, diamati selama 6 hari pertama perawatan. Data morbiditas dan mortalitasdiamati sampai pasien keluar dari rumah sakit. Uji statistik menggunakan X 2 dan Anova.Hasil. Terdapat penurunan kuantitas penggunaan antibiotik dan peningkatan kualitaspenggunaan antibiotik secara bermakna (p=0.000 dan p=0,000). Penurunan kuantitasantibiotiok terutama disebabkan pengurangan penggunaan antibiotik yang tidakdiperlukan. Tidak terdapat perbedaan lama rawat dan lama demam (p=0.96 dan p=0.32)dan tidak terdapat perbedaan kematian selama periode pengamatan.Kesimpulan. Dengan pedoman yang baik, penggunaan jumlah antibiotik dapatditurunkan tanpa meningkatkan risiko morbiditas dan mortalitas.

Abstract Abstract 3372 Background: Granulocyte transfusions (GTX) are used as an additional therapeutic option in patients with severe neutropenia following chemotherapy constituting an increased risk for life-threatening bacterial and fungal infections. We hypothesized that interventional GTX would provide a clinical benefit for neutropenic patients with invasive pulmonary aspergillosis (IPA). Methods: We reviewed the clinical outcome of 44 patients with severe neutropenia (46 cases) and underlying hematological malignancies suffering from IPA unresponsive to standard antifungal therapy. They received a total of 181 human recombinant granulocyte colony-stimulating factor (rh G-CSF) stimulated GTX at Freiburg University medical center from 1996 – 2009. Neutropenias were caused by conventional chemotherapy (n=38), conditioning chemotherapy for allogeneic (n=4) and autologous (n=2) hematopoietic cell transplantation (HCT), aplastic anemia (n=1) and by intense immunosuppressive (n=1). Donors were exclusively relatives and acquaintances of the recipients. IPA was diagnosed by clinic, computed tomography (CT) scan, serological or microbiological measures. Response of GTX was evaluated by repeated CT, decreasing C-reactive protein (CRP) levels, hematopoietic regeneration and clearance of serum galactomannan antigen. Results: A median of 3 GTX (range 1–25) containing a median total of 59.4×109 (range 3–170) white blood cells per GTX were administered. All but five (3%) transfusions were well tolerated. Median duration of neutropenia proceeding GTX was 15.5 d (range 4–70). Resolution of infection or clinical improvement was achieved in 29 (63%) patients with IPA and haematopoietic recovery has been assumed within 10 days after the last GTX in 34 patients (74%). Thirty-three (72%) patients were alive one month after the first GTX. Overall, progressive malignant disease was the main cause of death. Patients not responding to GTX died without on septic complications despite appropriate antibacterial and antifungal treatment. Nine out of 26 neutropenic patients receiving GTX after conventional chemotherapy underwent allogeneic HCT later on after control of IPA. Conclusions: Rh G-CSF stimulated GTX are a safe and effective therapeutic tool for patients with hematological malignancies suffering from profound neutropenia and antifungal-therapy resistant IPA. GTX may serve as a bridging therapy in severe neutropenic patients with IPA scheduled for allo-HCT. Disclosures: Bertz: GILEAD: Research Funding; MSD: Membership on an entity's Board of Directors or advisory committees.

Neutropenia is a common complication of chemotherapy in leukemic patients. An herbal formulation of chamomile was hypothesized to be effective on neutropenia. A group of healthy volunteers and two groups of patients received chamomile oral drop to be compared with a control group of neutropenic patients. Results showed an increase of white blood cells and resolution of neutropenia in all groups except for the control group. In conclusion, chamomile could be used as an effective complementary medicine for increasing the immunity of neutropenic patients (in addition to healthy individuals). Keywords: Chamomile; Leukemia; Chemotherapy; Neutropenia; Integrative Medicine; Persian Medicine