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Query: UMLS:C0027947 (neutropenia)
 17,527 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The occurrence and significance of haematological abnormalities were analysed in 126 prospectively studied patients with systemic lupus erythematosus. Haemolytic anaemia occurred in 13 per cent, neutropenia in 47 per cent, lymphocytopenia in 20 per cent and thrombocytopenia in 27 per cent of all patients. Patients with haemolytic anaemia were less likely to have serositis, but no differences in the incidence of renal or cerebral manifestations were found between the various groups. Infections were mainly associated with the use of corticosteroid therapy. Life-table analysis showed no adverse influence on survival of haemolytic anaemia, neutropenia or lymphocytopenia, but late onset thrombocytopenia was associated with a decreased survival. No relationship was found between thrombocytopenia and the presence of antiphospholipid antibodies or the occurrence of thromboembolic events. We conclude that late onset thrombocytopenia in patients with systemic lupus erythematosus is associated with a decreased probability of survival but this could not be attributed to thromboembolic events.
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PMID:Prevalence and significance of haematological abnormalities in patients with systemic lupus erythematosus. 194 40

Clinical and laboratory data of 143 patients with primary or secondary autoimmune neutropenia (AIN) were evaluated. Primary AIN was found predominantly in children below 3 years, whereas secondary AIN was more frequent in patients 40-60 years of age. Female patients with primary AIN were slightly more prevalent (54%) than male patients (46%). The peripheral blood count showed normal or diminished leukocyte counts with median absolute neutrophil counts of 250 cells/microliters. In 38% of the patients neutropenia was accompanied by monocytosis. Bone marrow examination revealed in 95% a normo- or hypercellular marrow with a marked reduction of mature neutrophils in 56% of the specimens. Twenty-three percent of the sera showed specificity for the NA1 antigen. Patients were usually affected by benign bacterial infections of the skin and of the upper respiratory tract, as well as by recurrent otitis media. Infections were treated symptomatically, and only six patients required continuous administration of antibiotics. Remission of neutropenia during treatment occurred in three of six patients treated with intravenous immunoglobulin G and in three of four patients who received steroid therapy. Except for one patient neutropenia relapsed after discontinuation of therapy. During a follow-up of 6-36 months, spontaneous remission has been observed in four patients.
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PMID:Autoimmune neutropenia: clinical and laboratory studies in 143 patients. 195 48

We reviewed 91 cases of pediatric Escherichia coli bacteremia during a 10-year period. Thirty one patients were afebrile; a significantly greater proportion of these patients were aged less than 1 month, had ampicillin-resistant E coli isolates, or had persistent bacteremia 24 hours after initiating antibiotic therapy. Infection was community acquired in 65 cases; associated urinary tract infection was six times more common in this setting than in nosocomially acquired infections. In 85 cases at least 1 underlying medical condition/focus of infection was identified at the time the positive blood culture was obtained, the most common were immune deficiency states (38 cases), urinary tract infection (29 cases), and lesions of the gastrointestinal tract (27 cases). Polymicrobial bacteremia occurred in five cases. Twelve patients died; significantly associated with death were hypotension requiring pressor therapy, presence of a central venous catheter, and neutropenia.
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PMID:Escherichia coli bacteremia in children. A review of 91 cases in 10 years. 203 96

Although major advances in the treatment of cancer have resulted in improved survival rates, serious infections continue to be a major source of morbidity and mortality in the immunocompromised patient. Patients may experience prolonged periods of bone marrow suppression accompanied by neutropenia as a result of the underlying disease, and as a result of treatment with myelosuppressive chemotherapy, intensive radiotherapy, or both. Neutropenia is the single most important factor predisposing patients with cancer to infection. The risk of developing infection increases as neutropenia persists, and this risk is consistently greater at lower neutrophil levels. Infection in a patient with neutropenia is regarded as an emergency situation requiring immediate action; progression of localized to disseminated infection leading to sepsis may be so rapid that, if not detected early, mortality is high. In the presence of neutropenia, the manifestation of infection leading to life-threatening septicemia is altered. The usual signs and symptoms of infection may be minimal or absent, hindering early and accurate diagnosis of infection. To provide a means of early and more accurate diagnosis of infection in the patient with neutropenia, a nursing protocol has been developed that incorporates preventive interventions, guidelines for early detection of impending infection, and measures to control infection.
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PMID:Nursing protocol for the patient with neutropenia. 210 83

Infection is a common problem for bone marrow transplant (BMT) recipients during the period of neutropenia that immediately follows the procedure. Gram-negative infections present a particular hazard in these immunocompromised hosts. To augment host defenses against one such pathogen, Pseudomonas aeruginosa, we immunized bone marrow transplant donors and/or recipients with a polyvalent O-polysaccharide-toxin A conjugate vaccine. When either donor or recipient alone was vaccinated before transplant, no increase in specific antibody titers to any of the vaccine components was observed in the recipient. However, when both donor and recipient were vaccinated before transplant, increases in antibody titers to all polysaccharide components occurred to levels shown to be protective in animal models of gram-negative sepsis. Specific antibodies were primarily of the IgG1 and IgG2 subclass even though IgG2 subclass deficiency is common after BMT. The requirement for both donor and recipient immunization reflects the need for primed donor B lymphocytes in the marrow inoculum to be transferred into an antigen-containing environment so that maximum B-cell proliferation and antibody secretion can occur. Adoptive transfer of antibody responses to Pseudomonas aeruginosa and other common bacterial pathogens has the potential to reduce infection-related morbidity and mortality after allogeneic bone marrow transplantation.
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PMID:Immunity against Pseudomonas aeruginosa adoptively transferred to bone marrow transplant recipients. 212 33

Myelodysplasia, characterized by varied reductions of peripheral blood elements with normal or hypercellular bone marrow, is relatively frequent among older patients and may evolve to acute leukemia. We reviewed findings in 35 patients whom, according to the FAB classification were distributed as follows: simple refractory anemia (RA) 34%, sideroblastic refractory anemia (SRA) 14%, refractory anemia with excess blast forms (RAEB) 31%, chromic myelomonocytic leukemia (CMML) 12% and refractory anemia with excess blast forms in transformation (RAEBT) 9%. Cytogenetic studies performed in 16 patients were abnormal in 5 (31%), all among patients with poor prognosis forms of the disorder. All patients had anemia; thrombopenia and neutropenia were more frequent in subtypes RAEB, CMML and RAEBT). Mean survival rate was 30 months, significantly greater in RA and SRA compared to the other groups. Infections and development of acute leukemia were the causes of death.
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PMID:[Myelodysplasias: clinical experience with 35 patients]. 215 45

Studies with fluconazole in oropharyngeal candidiasis have focused primarily on three groups of infections: chronic atrophic candidiasis, oropharyngeal infections associated with either neutropenia or AIDS, and chronic mucocutaneous candidiasis. In two studies of chronic atrophic candidiasis associated with dentures, 82 patients received 7 or 14 days of therapy with fluconazole (50 mg daily). Clinical and mycologic cure rates ranged from 69% to 100%, with the best results occurring with 14 days of therapy in combination with the cleansing of dentures. Thirteen patients with oroesophageal candidiasis associated with chronic mucocutaneous candidiasis were treated with 50 or 200 mg of fluconazole daily, and clinical and mycologic remissions were achieved in a mean period of 10 days. So far 95 patients have been treated with fluconazole for oropharyngeal candidiasis associated with malignancy, therapeutic immunosuppression, AIDS, or AIDS-related complex. Infection was cured by clinical criteria in 84% of those studied. While the majority of patients with clinical cure had significant reductions in the number of yeast colonies, only 48% had negative oral cultures at the end of therapy with courses of 50 mg of fluconazole daily for 5 days to 8 weeks.
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PMID:Overview of studies of fluconazole in oropharyngeal candidiasis. 218 11

We have evaluated the use of high-dose intravenous ciprofloxacin as monotherapy in the empirical therapy of febrile episodes in neutropenic patients during the course of a randomized trial comparing ciprofloxacin with a standard combination regimen. Sixty-four episodes of fever were studied in a high risk population of 42 patients mostly undergoing intensive chemotherapy for leukaemia. Ciprofloxacin achieved clinical responses as follows: completely successful in 39%, partially successful in 20%, and unsuccessful in 41%. Infections were microbiologically documented in 37 (58%), with Gram-positive bacteria (of which 37% were coagulase negative staphylococci and 34% were streptococci) accounting for 81% of all organisms cultured. Responses in documented infections were as follows; completely successful in 32%, partially successful in 27%, and unsuccessful in 41%. One infection-related death occurred 30 h after starting ciprofloxacin, and a further three patients died before the resolution of neutropenia. The early death was caused by fulminant infection with a ciprofloxacin-resistant Pseudomonas aeruginosa. No other ciprofloxacin resistance was seen amongst eight Gram-negative isolates. There was no evidence of emerging ciprofloxacin resistance during the course of the study. Ciprofloxacin was associated with a low incidence of adverse events with skin rash (five cases) and nausea (one case) being reported as possibly or probably related to ciprofloxacin. We conclude that high-dose intravenous ciprofloxacin may be safely employed as monotherapy in the empirical treatment of febrile episodes in neutropenic patients. It has the additional advantages of twice daily administration, the availability of intravenous and oral presentations, and absence of cross-allergy in beta-lactam antibiotic hypersensitive patients.
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PMID:High dose intravenous ciprofloxacin in febrile neutropenic patients. 229 37

Granulocyte transfusions are increasingly being used as therapy for newborns with sepsis and neutropenia. We injected either group B Streptococcus or phosphate-buffered saline solution intraperitoneally into adult and newborn rats. Human granulocytes, labeled with chromium 51, were transfused seven hours later. When the newborn rats were killed 13 to 19 hours after injection, they had 10(2) to 10(6) cfu/gm Streptococcus organisms in both lung and brain. Only one third of the adult rats had 10(2) to 10(4) cfu/gm Streptococcus organisms in either lung or brain. A greater proportion of the transfused granulocytes was present in lung and brain tissue of newborn rats, compared with adult rats (p less than 0.05), irrespective of infection. Granulocyte transfusion did not change the peripheral blood leukocyte count in adult rats but increased the count in newborn rats (p less than 0.05). The immature myeloid pool in the bone marrow of adult rats increased significantly with either infection or transfusion (p less than 0.01). The immature pool in newborn rats increased significantly only with infection (p greater than 0.001), although the combination of infection and transfusion also had a significant effect on the pool (p less than 0.01). Infection and both infection and transfusion, but not transfusion alone, significantly affected the mature myeloid bone marrow pool in adult and newborn rats (p less than 0.001). The depletion of the mature myeloid elements of the bone marrow in response to infection was dramatic in neonatal rats, compared with that in adult rats. Both transfused granulocytes and hematogenously spread streptococci lodge in the brains and lungs of neonatal rats more effectively than in those of adult rats.
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PMID:Granulocyte transfusions in septic adult and newborn rats: distribution of granulocytes and effect on peripheral blood and bone marrow. 231 59

The clinical courses of 26 patients with severe neutropenia after application of cytostatic agents are demonstrated. The symptomatology reaches from complete freedom of complaints to severe and most severe clinical appearances. In all 7 asymptomatic patients a complete remission of the changes of the blood picture occurred. Patients with lacking or partial remission of the blood picture after severe neutropenia induced by cytostatic agents have in general a bad prognosis quoad vitam. Infections are the most important complication of a severe neutropenia. Conclusions for the clinical practice concerning the prophylaxis and the early recognition of severe neutropenias as well as of neutropenic complications are derived. Irreversible lesions of the bone marrow by cytostatic agents are notifiable unwished effects of drugs.
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PMID:[Severe neutropenia following cytostatic drug therapy--clinical symptoms, follow-up and prognosis in 26 patients of a district hospital]. 237 34


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