Bhatnagar Shishir, Chandra Jagdish, Narayan Shashi
Department of Pediatrics, Kalawati Saran Children Hospital, India.
J Trop Pediatr. 2002 Aug;48(4):200-3. doi: 10.1093/tropej/48.4.200.
A total of 30 episodes of neutropenia in 16 patients of acute lymphoblastic leukemia, aged between 1 and 12 years were studied prospectively. In the initial treatment phase (induction of remission, consolidation and CNS prophylaxis) 92.8 per cent episodes were prolonged (> 7 days) and 85.7 per cent of them had profound neutropenia (absolute neutrophil counts < 0.200 x 10(9)/l). In contrast, in the maintenance phase, only 64.2 per cent were of prolonged duration; of them 57.1 per cent had profound neutropenia. Most patients in neutropenia of prolonged duration had anemia (Hb < 8 g/100 ml) and thrombocytopenia (platelet < 100 x 10(9)/l). Regularly increasing trends were seen in total leucocyte counts (TLC), absolute monocyte counts (AMC) and platelet counts from 4 days prior to recovery of absolute neutrophil counts (ANC). Of all the parameters, platelet count (> 100 x 10(9)/l) and AMC (> 0.1 x 10(9)/l) recovered 4 and 1 days, respectively, prior to recovery of ANC above 0.5 x 10(9)/l. Recovery of platelet counts (4 days prior to recovery of ANC) and possibly AMC can be considered early predictors of bone marrow recovery. These parameters can be used in conjunction with clinical condition to decide about early discharge of leukemia patients with neutropenia, especially in developing countries where prolonged stay can result in hospital acquired infections.
对16例年龄在1至12岁的急性淋巴细胞白血病患者共30次中性粒细胞减少发作进行了前瞻性研究。在初始治疗阶段（诱导缓解、巩固和中枢神经系统预防），92.8%的发作持续时间延长（>7天），其中85.7%有严重中性粒细胞减少（绝对中性粒细胞计数<0.200×10⁹/L）。相比之下，在维持阶段，只有64.2%的发作持续时间延长；其中57.1%有严重中性粒细胞减少。大多数中性粒细胞减少持续时间延长的患者有贫血（血红蛋白<8g/100ml）和血小板减少（血小板<100×10⁹/L）。从中性粒细胞绝对计数（ANC）恢复前4天开始，白细胞总数（TLC）、单核细胞绝对计数（AMC）和血小板计数呈规律性上升趋势。在所有参数中，血小板计数（>100×10⁹/L）和AMC（>0.1×10⁹/L）分别在ANC恢复至高于0.5×10⁹/L前4天和1天恢复。血小板计数的恢复（ANC恢复前4天）以及可能的AMC可被视为骨髓恢复的早期预测指标。这些参数可与临床状况结合使用，以决定中性粒细胞减少的白血病患者能否提前出院，尤其是在长期住院可能导致医院获得性感染的发展中国家。
