Retrospective analysis of children with cytopenia secondary to infection

Objective: Cytopenes secondary to infection in healthy children are quite common. Neutropenies secondary to infection are usually benign and resolves spontaneously. However, these patients often receive unnecessary antibiotics even if the underlying factor is viral infections.Purpose of our study is to define the clinical and laboratory characteristics of patients with cytopenia due to the infectious causes,and to reveal the relationship between duration of cytopenia and sex, age, cell counts at admission(hemoglobin, leukocyte, thrombocyte, monocyte, absolute neutrophil count, lymphocyte count), C-reactive protein and procalcitonin, and iron, iron binding, ferritin, vitamin B12, folic acid levels.In addition, iron, iron binding, ferritin, folate and B12 levels were examined in relation to the neutropenia and lymphopenia of these nutrients. METHODS: The files of 70 patients who were admitted to the Pediatric Hematology-Oncology outpatient clinic of Bezmialem Vakif University Hospital between August 2015 and August 2016 for cytopenia and identified as cytopenia secondary to an infection were retrospectively reviewed. As demographic and clinical characteristics of patients; age, gender, complaints at admission, examination findings, diagnoses, length of hospital stay, and antibiotics were recorded. As laboratory findings; complete blood counts at admissions and end of disease (hemoglobin, leukocyte, thrombocyte, monocyte, absolute neutrophil count, lymphocyte count), value of C-reactive protein and procalcitonin, sedimentation, lactate dehydrogenase and uric acid values for malignancy differential diagnosis, viral markers, culture results, vitamin B12, folic acid, iron, iron binding, ferritin values, peripheral smear findings were recorded. Findings: Seventy patients were included in the study. 74.3% (n = 52) of the children were treated outpatiently; 12.9% (n = 9) were hospitalized in the child care service, and 12.9% (n = 9) were in the intensive care unit. In 70.0% of the children (n = 49) the cytopenias were seen resolve to follow-up and 1 case was lost. Twenty cases did not countinue follow up. Neutropenia was detected in 44 (62.8%) of the cases. In 13.6% (n = 6) of these patients, severe, 43% (n = 19) moderate and 43% (n = 19) mild neutropenia were observed. Thrombocytopenia was detected in 41 (58.6%) ,and lymphopenia was detected 23 (32.9%) of cases (32.9%) . The mean duration of neutropenia ranged from 2 to 73 days with a mean of 13.74 ± 15.05 days and the mean duration of lymphopenia ranged from 2 to 13 days and the mean duration of thrombocytopenia recovery ranged from 2 to 42 days with a mean of 8.53 ± 7.41 days. The number of leukocyte, absolute neutrophil, lymphocyte, monocyte, hemoglobin, and platelet counts, antibiotic usage, C-reactive protein and procalcitonin levels in the lymphocyte and neutrophil counts resolving before 10 days and 10 days and after; there was no significant difference (p> 0.05). There was no statistically significant difference in vitamin B12, ferritin, total iron binding capacity and iron levels between the groups 10 days before and 10 days after the return of lymphocyte and neutrophil numbers to normality (p> 0.05). There was a statistically significant difference between the folate levels (p = 0.016, p <0.05); The folate levels of those who recovered over ten days are significantly higher than those recovering below ten days. Conclusion: Cytopenias secondary to infection in pre-existing healthy children are benign and transient. It frequently develops secondary to viral infections. The most common is neutropenia and is usually associated with anemia or thrombocytopenia. There is no relation between age, sex, and number of cells in the application with the duration of the cytopenia. Cytopenic time was found to be longer in patients with high levels of folic acid, incompatible with vitamin B12.