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Leukopenia in critically ill children

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Dr Swati Y Bhave, Adjunct Professor in Adolescent Medicine; Dr D Y Patil Medical College, & Dr D Y Patil Vidyapeeth, Pune; Sr. consultant, Adolescent Pediatrics & Head-In-charge of Adolescent Wellness Clinic, Jehangir Hospital Pune    07 January 2023

Leukopenia in children receiving intensive care is indicative of increased risk of unfavourable outcomes and mortality, according to a study published in the December 2022 issue of the Journal of Paediatrics and Child Health.1

 

In this study, researchers included 200 children hospitalized in the pediatric ICU from June 2018 to August 2018. Children with pre-existing immune deficiency and those diagnosed with a malignancy were excluded from the study group. The median age of the participants was 2.2 years. Thirty-nine (20%) children were admitted to the PICU due to respiratory illnesses. A little over half (52%; n = 103) were post-surgery patients; of these, 68 (34%) had undergone cardiac surgery.

 

Sixty-three (31.5%) children had lab-confirmed infections. In the first week of their stay in the PICU, 135 (67.5%) had leukopenia; 117 (58.5%) out of these 135 patients had only lymphopenia, 16 (8%) had both lymphopenia and neutropenia, while 2 (1%) patients just had neutropenia.

 

Follow-up blood count data was available for 69 children; 33 had resolution of lymphopenia within 48 hours of their stay in the ICU. In 20 (29%) children, the lymphopenia corrected by 4 days, while in 10 children, the lymphopenia improved in a week.

 

Children with lymphopenia were more likely to undergo cardiac surgery, the cardiopulmonary bypass time was longer; they also required invasive ventilation and treatment with vasopressor/inotrope and consequently prolonged hospitalization. The chances of organ failure on the 4th day of admission was higher among children with lymphopenia.

 

This study highlights the role of leukopenia as a marker of “altered immunity” in critically-ill children in PICU predisposing them to the risk of infections and thereby of adverse prognosis. It is a simple and easily available marker to identify at-risk patients. The authors however suggest more studies with follow-up of blood counts “to determine the course and outcomes of lymphopenia”.

 

Reference

 

  1. Nallasamy K, et al. Prevalence and outcome of lymphopenia in the Paediatric Intensive Care Unit: A prospective observational study. J Paediatr Child Health. 2022 Dec;58(12):2203-2210. doi: 10.1111/jpc.16183. 

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