Browsing by Author "Vujić, Dragana (16647611700)"

In immunocompromized patients, including hematopoietic stem cell transplant (HSCT) recipients, life-threatening toxoplasmosis may result from reactivation of previous infection. We report a case of severe disseminated toxoplasmosis that developed early after allogeneic HSCT for T-cell lymphoblastic leukemia/lymphoma in a 15-year-old Toxoplasma gondii-seropositive boy with Nijmegen breakage syndrome, a rare genetic DNA repair disorder associated with immunodeficiency. The donor was the patient's HLA-identical brother. Prophylaxis with cotrimoxazole was discontinued a day before the HSCT procedure. Signs of lung infection appeared as early as day 14 post-HSCT. The presence of tachyzoite-like structures on Giemsa-stained bronchoalveolar lavage (BAL) fluid smears suggested toxoplasmosis. Real-time PCR targeted at the T. gondii AF146527 gene revealed extremely high parasite burdens in both blood and BAL fluid. Although immediate introduction of specific treatment resulted in a marked reduction of the parasite load and transient clinical improvement, the patient deteriorated and died of multiple organ failure on day 39 post-HSCT. Direct genotyping of T. gondii DNA from blood and BAL fluid with the PCR-restriction fragment length polymorphism method revealed type II alleles with SAG1, SAG2, and GRA6 markers but alleles of both type I and type II with GRA7. Additional analysis with 15 microsatellite markers showed that the T. gondii DNA was atypical and genetically divergent from that of the clonal type I, II, and III strains. This is the first report of increased clinical severity of toxoplasmosis associated with an atypical strain in the setting of immunosuppression, which emphasizes the need to diagnose and monitor toxoplasmosis by quantitative molecular methods in cases of reactivation risk. Copyright © 2013, American Society for Microbiology.

Introduction The Hickman catheter is a tunneled, open-type catheter often implanted in children for long-term intravenous treatment. Their application can cause numerous complications. Catheter breakage and dislocation of fragments to the intravascular system is a rare but life-threatening condition. When a complication occurs, depending on the patient’s clinical condition, the first step is transcutaneous endovascular removal of the catheter’s fragment. If this is not possible, surgical thoracotomy is necessary. The objective of this article was to present a case of breakage and dislocation of Hickman catheter in a pediatric patient, as well as the diagnostic and therapeutic approach to complications. Case outline We report a 14-month-old child who had a Hickman catheter because he was undergoing treatment for acute juvenile myelomonocytic leukemia. Due to a malfunction of the catheter, the existing catheter had to be removed. During the surgical procedure, a breakage and dislocation of the catheter fragment occurred. A chest X-ray and an echocardiography confirmed the position of the catheter fragment in the right atrium. A transcutaneous endovascular procedure was successfully performed to remove the fragment of the catheter. Conclusion Numerous complications can occur during the insertion, management, and removal of long-term catheters. It is necessary to periodically control the catheter’s position by chest X-ray and ultrasound of the heart and neck. If a particular complication is detected, an individual approach to treatment with the lowest risk to the patient should be chosen. Dislocated fragments of the Hickman catheter can be safely removed by endovascular transcatheter procedures. © 2024, Serbia Medical Society. All rights reserved.

B-cell acute lymphoblastic leukemia (B-ALL) is a hematopoietic malignancy characterized by overproduction of immature B-lymphoblasts. B-ALL is the most common pediatric tumor and remains the leading cause of mortality in children and adolescents. Molecular and cytogenetic analyses of B-ALL revealed recurrent genetic and structural genomic alterations which are routinely applied for diagnosis, prognosis and choice of treatment regimen. The present case report describes a 4-year-old female diagnosed with B-ALL. GTG-banding at low resolution revealed an abnormal clone with 46,XX,?t(X;19)(q13;q13.3),der(9) besides normal cells. Molecular cytogenetics demonstrated a balanced translocation between chromosomes 16 and 19, and an unbalanced translocation involving chromosomes 5 and 9. A locus-specific probe additionally identified that the FUS gene in 16p11.2 was split and its 5' region was translocated to subband 19q13.33, whereas the 3' region of the FUS gene remained on the derivative chromosome 16. Overall, this complex karyotype included four different chromosomes and five break events. Further analyses, including array-comparative genomic hybridization, additionally revealed biallelic deletion of the tumor suppressor genes CDKN2A/B, and deletion of the NR3C1 and VPREB1 genes. The patient passed away under treatment due to sepsis. © 2020 Spandidos Publications. All rights reserved.

B-cell acute lymphoblastic leukemia (B-ALL) is a hematopoietic malignancy characterized by overproduction of immature B-lymphoblasts. B-ALL is the most common pediatric tumor and remains the leading cause of mortality in children and adolescents. Molecular and cytogenetic analyses of B-ALL revealed recurrent genetic and structural genomic alterations which are routinely applied for diagnosis, prognosis and choice of treatment regimen. The present case report describes a 4-year-old female diagnosed with B-ALL. GTG-banding at low resolution revealed an abnormal clone with 46,XX,?t(X;19)(q13;q13.3),der(9) besides normal cells. Molecular cytogenetics demonstrated a balanced translocation between chromosomes 16 and 19, and an unbalanced translocation involving chromosomes 5 and 9. A locus-specific probe additionally identified that the FUS gene in 16p11.2 was split and its 5' region was translocated to subband 19q13.33, whereas the 3' region of the FUS gene remained on the derivative chromosome 16. Overall, this complex karyotype included four different chromosomes and five break events. Further analyses, including array-comparative genomic hybridization, additionally revealed biallelic deletion of the tumor suppressor genes CDKN2A/B, and deletion of the NR3C1 and VPREB1 genes. The patient passed away under treatment due to sepsis. © 2020 Spandidos Publications. All rights reserved.

Objectives: The human cytomegalovirus is a notorious pathogen in the pediatric transplant setting. Although studies on factors in complicity with cytomegalovirus infection abound, the roles of age, sex, allogeneic hematopoietic stem cell transplant modality, and type of underlying disease (malignant vs nonmalignant) with regard to cytomegalovirus infection and viral load in children are seldom explored. Our aim was to examine the significance of these factors on cytomegalovirus infection and viral load in Serbian pediatric recipients of allogeneic hematopoietic stem cell transplant. Materials and Methods: Thirty-two pediatric recipients of allogeneic hematopoietic stem cell transplant to treat various malignant and nonmalignant disorders were prospectively monitored for cytomegalovirus infection. The real-time quantitative polymerase chain reaction was used for pathogen detection and quantitation. Demographic and virologic parameters were statistically analyzed with SPSS statistics software (version 20). Results: Cytomegalovirus DNA was detected in 23 patients (71.9%). Infection occurred significantly more often (P = .015) in patients with haploidentical donors. The opposite was noted for matched sibling grafts (P = .006). Viral load was higher in female patients (P = .041) and children with malignant diseases (P = .019). There was no significant relationship between viral infection or load and medical complications. Conclusions: Transplant recipients presented with a high incidence of cytomegalovirus viremia. The modality of allogeneic hematopoietic stem cell transplant was associated with the frequency of cytomegalovirus infection. Age, sex, type of underlying disease, and medically relevant events were not conducive to occurrences of viremia. Notably, we observed substantial viral loads in female patients and patients with neoplastic diseases. Studies comprising larger populations are needed to better understand these results. © Başkent University 2021 Printed in Turkey. All Rights Reserved.

Background/Aim. Transfusion reaction is an adverse event which manifests during or after administration of blood components to the patient. We aimed to show less known aspects of most common transfusion reactions (allergic and febrile non-hemolytic transfusion reactions - FNHTR) in the pediatric population at the platelet concentrates. The aim of this study was to determine the role of the accumulated cytokines interleukin-6 (IL-6), interlekin- 8 (IL-8) and presence of anti-platelet antibodies in the etiology of transfusion reaction in children. Methods. The study included 239 pediatric patients, who received platelet concentrates. Data of reported transfusion reaction were collected and evaluated prospectively. The levels of IL-6 and IL-8 were determined using an immunoassay. Antihuman leukocyte antigen antibodies (anti-HLA) and antihuman platelet antigen antibodies (anti-HPA) were identified by Luminex flow cytometry. Results. Toral of 70 transfusion reactions were recorded 52 patients. Allergic reactions occurred in most of the cases (74.3%), followed by FNHTR (17.1%). Platelets derived from buffy coat caused the majority of reactions (73.5%). Patients with infection after platelet transfusion with FNHTR had the highest levels of IL-6, 483.30 ± 1,041.79 pg/mL (p = 0.020). Respectively, the febrile patients had IL-6, 302.52 ± 720.04 pg/mL (p = 0.004). The level of IL-8 in platelet units that caused transfusion reactions was 95.66 ± 319.10 pg/mL, which was significantly higher (p = 0.001) compared to the control platelet units. Conclusion. The predominant etiologic mechanism for FNHTR in our study was leukocyte derived cytokine accumulation during storage. Etiopathogenesis of FNHTR induced by IL-6 and IL- 8 presented differently. We concluded that significant factors in the etiology of FNHTR by IL-6 were the factors related to the pediatric patient (infection, inflammation). © 2018, Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Introduction: ABO blood type changes after ABOincompatible hematopoietic stem cell transplantation (HSCT). Most non-hematopoietic tissues retain the expression of the patient s own ABO antigens, which may adsorb from the plasma onto the donor s red blood cells (RBCs). Because of this phenomenon, a persistent patient s A and/or B antigen could be detected in the laboratory, despite 100% white cell donor chimerism. Adsorption of the patient s soluble ABO antigens on the newly formed RBCs complicates the interpretation of the patient s blood type and decision of transfusion therapy. Case Presentation: The first case report is a 6-year-old girl, A, D+, with T-cell acute lymphoblastic leukemia (ALL), transplanted with HLAmatched unrelated group O, D+ bone marrow. A second case report describes an 8-year-old girl, AB, D-, with ALL transplanted with an HLA-matched related group B, D+ bone marrow. The presence of persistent antigen A was registered in both patients more than 1 year after HSCT, despite complete donor chimerism. Conclusion: The weak expression of ABO antigens on RBCs after HSCT should be examined in detail for proper planning of transfusion therapies. © 2024 The Author(s).

Background: Engraftment after hematopoietic stem cell transplantation is the recovery rate of neutrophils and platelets. This study aimed to test the impact of the patient's general characteristics, pre-transplantation factors, and quality parameters of hematopietic stem cell products on hematopietic recovery and to define predictive factors for engraftment in children. Methods: This retrospective study included 52 patients aged from 1 to 18 years old treated with autologous transplantation at the Mother and Child Health Care Institute of Serbia “Dr. Vukan Čupić” in Belgrade, from January 2013 until December 2018. Data were collected from medical records and apheresis procedure protocols. SPSS 20.0 software package was used for statistical data processing. Results: The median neutrophil engraftment was 18.0 (16.0–22.5) days, while the median platelet engraftment was 11.0 (10.0–18.0) days. Statistically significant correlations were found between neutrophil engraftment and patient's age (p-value = 0.050), body weight (p-value = 0.021), diagnosis (p-value = 0.023), source of stem cells (p-value = 0.001), and the number of CFU-GM/kg (p-value = 0.018). A statistically significant correlation was found between platelet engraftment and the time from diagnosis to the transplantation (p-value = 0.043), source of stem cells (p-value = 0.009), and the number of CD34+ cells/kg (p-value = 0.014). Conclusions: Predictive factors for hematopoietic recovery in this study were the patient's age, body weight, diagnosis, time from diagnosis to hematopoietic stem cell transplantation, source of hematopietic stem cells, the number of CD34+ cells/kg, and the number of CFU-GM/kg. © 2024 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular