Asunto(s)
Trasplante de Médula Ósea , Transfusión de Plaquetas , Transfusión de Componentes Sanguíneos , Plaquetas/inmunología , Transfusión de Sangre Autóloga , Trasplante de Médula Ósea/inmunología , Neoplasias de la Mama/inmunología , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/terapia , Criopreservación , Femenino , Antígenos HLA , Humanos , Neoplasias Ováricas/inmunología , Neoplasias Ováricas/cirugía , Neoplasias Ováricas/terapia , PlaquetoferesisRESUMEN
This report describes the dramatic reduction in the platelet count and ablation of symptoms by consecutive platelet apheresis in a young girl with CML who presented with an extremely high platelet count of 10,320 x 10(9)/l. Extreme thrombocytosis, although quite rare, can be symptomatic and life-threatening in paediatric patients and should be considered an emergency. The mechanical removal of platelets by apheresis is effective therapy and should begin as soon as possible.
Asunto(s)
Leucemia Mielógena Crónica BCR-ABL Positiva/complicaciones , Plaquetoferesis , Trombocitosis/terapia , Niño , Femenino , Humanos , Recuento de Plaquetas , Trombocitosis/etiologíaRESUMEN
The rate of engraftment after autologous bone marrow transplantation (ABMT) is extremely variable and largely unpredictable. To identify factors influencing engraftment, we studied 35 patients with refractory germ cell tumors undergoing high-dose chemotherapy with carboplatin (900-2000 mg/m2) and etoposide (1200 mg/m2) with bone marrow rescue. Prior to the initiation of chemotherapy, bone marrow sufficient for two marrow infusions was harvested (range 0.86-4.82 x 10(8) nucleated cells per kg). All 35 patients received half of the collected bone marrow 3 days after the last dose of chemotherapy; 23 responders received a second round of the same chemotherapy followed by infusion of the second half of the bone marrow. Eighteen patients could be compared for the two transplant episodes. The "rate of engraftment" was defined as the unweighted mean of four parameters: 1) the number of days until the absolute granulocyte count surpassed 0.2 x 10(9)/liter, 2) the number of days until the absolute granulocyte count surpassed 0.5 x 10(9)/liter, 3) the number of days until the last platelet transfusion, and 4) the number of days until the reticulocyte count surpassed 25 x 10(9)/liter. No significant correlation was found between rate of engraftment and such factors as the number of nucleated cells per kg infused, the dose of chemotherapy, extent of prior chemotherapy, tumor response to the high-dose chemotherapy, age of the patient, or the days of granulocytopenic fever (all p greater than 0.20). In contrast, a close correlation was found for the number of units of platelets (p = 0.005) and red blood cells (p = 0.006) transfused following each of the two transplants. There was no significant difference between rate of engraftment after first and second transplantation. Comparison of these data with the results obtained in reported ABMT with separate harvests suggests that the characteristics of the infused marrow determine the rate of engraftment after ABMT. This model of repeated transplantation could provide an important tool for assessing the therapeutic efficacy of hematopoietic growth factors.