الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 137 |  |  |
| | | from | 137 | | |
Abstract
Febrile neutropenia is a major complication of antineoplastic therapy resulting in excessive morbidity and mortality in pediatric hematology–oncology patients
This work was done to elucidate whether the presence of mannose binding lectin (MBL2) and/or ficolin-2 (FCN2) polymorphisms influence the risk and the frequency of febrile neutropenia in children with malignancy.
This study was carried out on 38 pediatric patients, Thirty five of them diagnosed as ALL (17 pre B, 10 Common B, 8 T ALL) and three T cell lymphomas. They were 24 males and 14 females.Their range of age was 2-12 years. They were selected from The Pediatric Hematology and Oncology Unit, Menoufia University during the period from January 2017 until January 2018, after approval of Ethical Committee of Menofia Faculty of medicine and consents obtained from parents of the patients.
Methods:
Inclusion criteria:
Pediatric cancer patients receiving chemotherapy, who were presented with febrile neutropenia (either with a single oral or equivalent temperature of greater than 38.3ºC or two consecutive temperatures greater than 38.0 ºC in a 12-hour period lasting at least 1 hour, and absolute neutrophil count less than 500/mm3).
Exclusion criteria:
Patients with fever without neutropenia or neutropenia without fever.
The patients exposed to:
I- Diagnosis and classification of cancer was established by;
a) History and physical examination.
b) Laboratory investigations including:
i. Complete blood picture including hemoglobin, total leukocytic count with absolute neutrophil count and platelets count.
ii. Bone marrow aspiration.
iii. Immunophenotyping.
iv. Biopsy in cases of solid tumours.
II- Once fever was reported with neutropenia according to previously mentioned criteria, the child was subjected to:
1. Complete history taking with special consideration of the age, sex, the type of underlying malignancy and mode of presentation.
2. Careful physical examination with particular attention to common sitesof infection e.g. respiratory tract, perianal, perioral regions, gastrointestinal tract, genitourinary tract and systemic infections.
3. For each patient, the number of FN episodes, duration of the first FN episode and total duration of FN episodes during follow-up period were recorded.
4. For each febrile neutropenic patient, the following laboratory investigations were done:-
a. Complete blood picture with differential count. All febrile neutropenic episodes, ANC< 500/mm3 (severe neutropenia).
b. C-reactive protein -ESR.
c. Renal function tests: Serum urea and creatinine.
d. Liver function tests: ALT- AST- total and direct bilirubin.
e. Culures: blood (both bacteria and fungi and catheter culture if found), urine analysis and culture, stool analysis and culture.
5. Radiological:
a- Chest x ray.
b- CTchest if indicated.
c- CTsinuses if indicated.
6. Specific investigations: Mannose binding lectin 2 ( MBL2 ) by PCR-RFLP method and Ficolin-2 ( FCN2) genotyping by sequencing.
It was found that:
The prevelance of bacterial infections were (45.5%) in the following sequence: Gram positive bacteremia (30.3%) (staph aureus 6.1%, staph epidermidis 24.2%) and Gram negative organism (15.2%) in the form of actinobacter 3.03%, Ecoli 9.09% and Klebsiella 3.03%.
The number, duration of first febrile neutropenic episode and total duration of febrile neutropeni episodes were significantly higher in patients with medium/ high risk genotype of MBL2 than low risk genotype.