Red blood cell distribution width is not a reliable biomarker for low iron stores in children with cystic fibrosis

Low iron stores in children, absolute iron deficiency (AID), can lead to impaired neurodevelopment and requires iron therapy. In the presence of infection/inflammation, like in cystic fibrosis (CF), serum ferritin (SF) is not a reliable biomarker for AID. Red blood cell distribution width (RDW) is a promising alternative reported not to be influenced by infection in healthy children. Currently, there are no data on the diagnostic capacity of RDW to detect AID in pediatric CF patients. This was a prospective observational study that investigated iron status biomarkers in 53 Dutch pediatric CF patients. AID was defined using World Health Organization criteria for SF in stable patients (no recent pulmonary exacerbation) and C-reactive protein (CRP) ≤10 mg/l. Patients with AID had higher RDW levels than patients without AID (p = 0.019). An RDW ≥13.2% showed the following test statistics: sensitivity 100%; specificity 39.4%; positive predictive value 20%; and negative predictive value 100%. Furthermore, we found a correlation between RDW and CRP in the total group that originated from the stable patients (r = 0.308; p = 0.042). In conclusion, the diagnostic capacity of RDW for detecting AID in pediatric CF patients seems limited because RDW levels might also be influenced by chronic infection/inflammation in these patients.     

170例小儿急性白血病首诊时周围血象分析

目的 探讨首诊时外周血象对白血病诊断、治疗时的指导意义。方法 回顾10余年我院就诊的170例白血病患儿首诊时外周血象的变化。用法国产Hemacell Plus全自动血液细胞分析仪在严格质量控制下于首次抽骨髓前,由专人采取指尖血对170例急性白血病(AL)患儿首诊时进行周围血象中的白细胞、血小板计数及血红蛋白测定及幼稚细胞检查,并对结果进行了统计分析。结果 发现大部分患儿血小板计数中重度减少(BPC≤50×109／L 120例,占70.59％)、白细胞数多为减低或接近正常(WBC≤10×109／L 91例占53.53％)、多为中重度贫血(Hb≤90 g／L 148例占87.06％)。170例中有54例外周血片中可检出幼稚细胞,占31.76％。结论 小儿急性AL时血小板不同程度减低(占87％),呈中、重度贫血(占87.06％)。WBC多减低或接近正常(53.53％)。血片中检出幼稚细胞率(31.76％)。认为AL时外周血细胞数的变化可能与白血病细胞的类型、数量及其形成的张力对髓血屏障的累积程度以及骨髓基质细胞的功能等因素有关。     

Double allogeneic peripheral blood stem cell transplantation in a 9-year-old patient with relapsed acute lymphoblastic leukemia: case report

A 9-year-old female patient with relapsed leukemia that was refractory to conventional reinduction chemotherapy was successfully treated with double allogeneic peripheral blood stem cell transplantation. The conditioning regimen for the first transplantation consisted of busulfan, etoposide, and melphalan, and that for the second transplantation was total body irradiation and thiotepa. Neither severe regimen-related toxicity nor graft-versus-host disease was observed. The patient is in complete remission without major complications for 5 years. Double transplantation should be considered as one of the possible treatments for refractory acute lymphoblastic leukemia.     

红细胞分布宽度对脓毒症患儿急性肾损伤的预测价值

目的 初步探讨红细胞分布宽度（RDW）对脓毒症患儿急性肾损伤（AKI）的早期预测价值。方法 126例脓毒症患儿根据是否合并AKI分为AKI组（66例）及非AKI组（60例）,另以RDW值的均数为界,分为高RDW组（58例）及低RDW组（68例）。比较各组年龄、性别比、体质指数（BMI）、急性生理和慢性健康评分（APACHE Ⅱ评分）、序贯器官衰竭估计评分（SOFA评分）、血清尿素氮（BUN）、肌酐（Cr）、尿酸（UA）、C反应蛋白（CRP）、血常规,并分析与RDW独立相关的因素。结果 AKI组与非AKI组在年龄、男女比例、BMI、CRP、SOFA评分、APACHE Ⅱ评分等方面的差异无统计学意义（P > 0.05）,AKI组的血清BUN、Cr、UA、RDW高于非AKI组（P < 0.05）。高RDW组与低RDW组在年龄、男女比例、BMI等方面的差异无统计学意义（P > 0.05）,但高RDW组的BUN、Cr、UA、CRP、SOFA评分、APACHE Ⅱ评分、血红蛋白、平均红细胞体积等较高（P < 0.05）。多元线性回归分析提示：与RDW独立相关的因素包括年龄、性别、APACHE Ⅱ评分、Cr、Hb、MCV。结论 脓毒症患儿红细胞分布宽度对于早期预测肾损伤具有一定的临床价值。