Clinical Characteristics And Prognosis Of Children With Neutropenia

Objective:Collecttig the clinical characteristics of 255 children with neutropenia,discuss possible etiology and prognosis to provide some clinical guidance for doctors.Methods:Clinical data of 255 children with neutropenia were collected from the pediatric department of Qingdao University Hospital from January 2019 to December 2021.The children were grouped into young children and old children according to age.The children were grouped into neutropenia and agranulocytosis according to the severity of neutropenia.According to the time when neutrophil returned to normal,the children were grouped into acute neutropenia and chronic neutropenia,and analyzed by statistical software.Results:1.General conditions:137 males(53.73%),118 females(46.27%)and 94 infants,78toddlers(67.45%),83 old children(32.55%).There were 114 cases with neutropenia(44.71%)and 141 cases with agranulocytosis(55.29%).There were 220 cases with acute neutropenia(86.27%)and 35 cases with chronic neutropenia(13.73%).There were no statistically significant differences between the severity and recovery time of ANC reduction and gender or age(P>0.05).2.Accompanying symptoms and diseases:Fever and/or cough in 171 cases(67.06%),limb pain in 1 case(0.39%),asymptomatic in 83 cases(32.55%),combined diagnosis of upper respiratory tract infection in 42 cases(16.47%),bronchitis in 48 cases(18.82%),pneumonia in 53 cases(20.78%).Asymptomatic patients in young children were significantly more than those in old children(χ~2=5.227,P=0.022).There were no statistically significant differences between the severity and recovery time of ANC reduction and the concomitant symptoms(P>0.05).3.Blood:51 children were complicated with anemia(20.00%),15 children were complicated with thrombocytopenia(5.88%).The incidence of anemia in young chidren was significantly higher than old children(χ~2=4.863,P=0.027).The incidence of thrombocytopenia in old children was significantly higher than young chidren(χ~2=5.470,P=0.019).The incidence of agranulocytosis in children with anemia was significantly higher than children without anemia(χ~2=4.585,P=0.032),while there were no statistically significant differences between the severity of ANC reduction in children and thrombocytopenia(P>0.05).There were no statistically significant differences between the recovery time of ANC and anemia or thrombocytopenia(P>0.05).4.Pathogen infection:A total of 125 children were tested for pathogen infection(49.02%).There were 88 cases without etiological infection,37 cases with positive etiological infection,and 34 cases with mycoplasma pneumoniae and/or virus infection,1staphylococcus aureus positive case and 2 fungal infection cases,including 1 case of candida albicans and 1 case of aspergillus infection.Age,severity of ANC reduction and recovery time have no statistically significant differences with etiological infection(P>0.05).5.Detection of autoantibody:53 children were examined for autoantibody(20.78%),and 9 children were positive for autoantibody,including 6 positive for antinuclear antibody,1 positive for anti-mitochondrial type 2 antibody,1 positive for anti-cardiolipin antibody,and 1 positive for anti-ds DNA antibody.The positive rate of autoantibody in old children was higher than young children(P=0.014).The severity of ANC reduction and recovery time have no statistically significant differences with autoantibody(P>0.05).6.Bone marrow hyperplasia:57 children underwent bone marrow puncture examination(22.35%),44 children had normal myeloid hyperplasia,and 13 children had reduced myeloid hyperplasia or maturation disorder.The incidence of myeloid hyperplasia in young chidren was significantly higher than old children(χ~2=4.149,P=0.042).The incidence of agranulocytosis in children with myeloid hyperplasia was significantly higher than children with normal myeloid hyperplasia(χ~2=13.422,P=0.000),and the recovery time of ANC in children have no statistically significant differences with myeloid hyperplasia(P>0.05).7.Genetic examination:Genetic examination was performed on 13 children(5.10%),including 6 children with normal genes and 7 children with abnormal genes.ELANE gene mutation was found in 2 children,and the age of the children have no statistically significant differences with the incidence of gene mutation(P>0.05).However,the incidence of agranulocytosis and chronic neutropenia in children with abnormal gene was significantly higher than children with normal gene(P<0.05).8.Treatment and follow-up:122 children received no special treatment(47.84%),regular observation and follow-up;133 children were hospitalized(52.16%).Among them,19 children were treated with G-CSF,and the average ANC of the children before treatment was(0.52±0.17)×10~9/L.After treatment,the ANC was(6.68±0.94)×10~9/L,and the ANC was significantly increased after G-CSF treatment(t=-6.862,P=0.000).In the 2 children with ELANE gene mutation,recurrent and severe infection occurred clinically,and ANC maintain between(0.1-0.2)×10~9/L.Conclusion:1.Any age of children can occur neutropenia,mainly infants and toddlers.2.Respiratory tract infection is the most common symptom,and mycoplasma pneumoniae and virus are common etiology.Asymptomatic cases are mainly infants and toddlers.3.The incidence of neutropenia combined with anemia in infants and toddlers is high,which is more likely to affect the proliferation and maturation of bone marrow granulocytes.The incidence of neutropenia combined with thrombocytopenia in old children is high,and the positive rate of autoantibodies is high.Asymptomatic cases are mainly infants and toddlers.4.For persistent neutropenia or neutropenia with recurrent infection,early genetic testing is necessary to facilitate the diagnosis of congenital neutropenia.5.Asymptomatic children do not need to be treated,but regular outpatient visits are required to follow up ANC changes.