Hematologic predictors of bone marrow recovery in neutropenic patients hospitalized for fever: implications for discontinuation of antibiotics and early discharge from the hospital.
Hematologic predictors of bone marrow recovery in neutropenic patients hospitalized for fever: implications for discontinuation of antibiotics and early discharge from the hospital.
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因发热住院的中性粒细胞减少症患者骨髓恢复的血液学预测因素：对停用抗生素和尽早出院的影响。
DOI：
10.1016/s0022-3476(05)82536-3
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发表时间：
1992
期刊：
影响因子：
--
通讯作者：
Buchanan,GR
中科院分区：
文献类型：
--
作者：
Griffin,TC;Buchanan,GR
我们评估了64名癌症儿童在107次连续发热和中性粒细胞减少症发作中，骨髓恢复前全血细胞计数变化的时间和模式。评价了来自全血细胞计数连续每日测量的四项指标：总白细胞计数、中性粒细胞绝对计数、吞噬细胞绝对计数和血小板计数。在这107次发作中的70次（65%）中，患者出院时中性粒细胞绝对计数低于500个细胞/mm 3; 24例患者出院时中性粒细胞绝对计数低于100个细胞/mm 3。然而，在这70次发作中，除1次外，所有发作均在出院前出现早期骨髓恢复的体征;在出院前2天或2天以上，分别有41%、49%、50%和39%的病例观察到这些患者的白细胞、中性粒细胞绝对值、吞噬细胞绝对值和血小板计数持续增加。尽管他们在出院时是骨髓减少的，但大多数患者在那时有多系骨髓恢复的迹象; 70名患者中有59名在我们研究的三个或四个测量值中增加。在出院时有骨髓恢复证据的69名患者中，没有一名患者复发发热。我们的结论是，在中性粒细胞减少期间因发热住院的癌症儿童外周血细胞计数增加，预示着骨髓即将恢复，通常在绝对中性粒细胞计数恢复到500个细胞/mm 3之前几天。我们在中性粒细胞减少症消退前成功地使这类患者出院表明，需要进一步的对照试验来评估停止抗生素治疗和提前出院的安全性和可行性。
We evaluated the timing and pattern of changes in the complete blood cell count that preceded marrow recovery during 107 consecutive episodes of fever and neutropenia in 64 children with cancer. Four measures derived from serial daily measurement of the complete blood cell count were evaluated: total leukocyte count, absolute neutrophil count, absolute phagocyte count, and platelet count. During 70 (65%) of these 107 episodes, patients were discharged with an absolute neutrophil count of fewer than 500 cells/mm3; 24 patients were discharged from the hospital despite an absolute neutrophil count of fewer than 100 cells/mm3. During all but one of these 70 episodes, however, signs of early marrow recovery were present before discharge; sustained increases were observed in these patients' leukocyte, absolute neutrophil, absolute phagocyte, and platelet counts 2 or more days before their discharge in 41%, 49%, 50%, and 39% of cases, respectively. Although they were neutropenic at discharge, most patients had signs of multilineage marrow recovery at that time; 59 of 70 had increases in three or four of the measurements that we studied. None of the 69 patients who had evidence of marrow recovery at discharge had recurrence of fever. We conclude that children with cancer who were hospitalized for fever during periods of neutropenia have increases in the peripheral blood cell count that herald imminent bone marrow recovery, often several days before the absolute neutrophil count recovers to 500 cells/mm3. Our success in discharging such patients before resolution of neutropenia suggests that further controlled trials are needed to evaluate the safety and feasibility of cessation of antibiotic therapy and early discharge from the hospital.