ANORECTAL PATHOLOGIES IN THE COURSE OF ACUTE LEUKAEMIAS: PREDICTIVE PARAMETERS Anorectal pathologies in leukemias
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Keywords
Acute Leukemia, Leukocyte count, mean platelet volume(MPV), Anorectal Pathologies
Abstract
Introduction. Patients with leukaemia are exposed to infections as long as they are neutropenic. During this period, anorectal pathologies are among the common foci of infection with high mortality. We aimed in this study to investigate the factors that may have a predictive effect for early diagnosis and rapid intervention in perianal complications occurring in neutropenic patients diagnosed with leukaemia.
Materials and Methods. A total of 90 patients with acute leukaemia, including 45 patients with anorectal pathology and 45 patients without anorectal pathology, were analysed. Demographics, blood group, BMI, haemogram and biochemical parameters at the time of diagnosis, types of perianal pathology were recorded.
Results. In the group of patients with anorectal pathology, WBC, lymphocytes, monocytes, LDH were significantly (p<0.05) higher and platelets, MPV, PCT were significantly (p<0.05) lower.
The multivariate model showed significant-independent (p<0.05) efficacy of WBC and MPV values in differentiating patients with and without anorectal pathology. A significant efficacy was observed at the WBC cut off of 17000 [area under the curve 0.656 (0.542-0.770)] and at the MPV cut off of 10 [area under the curve 0.667 (0.554-0.780)] in differentiating patients with and without anorectal pathology.
Discussion. Anorectal pathologies are common foci of infection in patients with acute leukaemia. Having predictive parameters that may help for early intervention will help the clinician. This is the first study in the literature comparing a control group and a group with anorectal pathologies in leukaemia patients and providing a cut-off for WBC.
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References
2. Chen, C.-Y., A. Cheng, S.-Y. Huang, W.-H. Sheng, J.-H. Liu, B.-S. Ko, M. Yao, W.-C. Chou, H.-C. Lin, and Y.-C. Chen, Clinical and microbiological characteristics of perianal infections in adult patients with acute leukemia. PloS one, 2013. 8(4): p. e60624.
3. Loureiro, R.V., V.P. Borges, A.L. Tome, C.F. Bernardes, M.J. Silva, and M.J. Bettencourt, Anorectal complications in patients with haematological malignancies. European Journal of Gastroenterology & Hepatology, 2018. 30(7): p. 722-726.
4. Hansen, B.-A., Ø. Wendelbo, Ø. Bruserud, A.L. Hemsing, K.A. Mosevoll, and H. Reikvam, Febrile neutropenia in acute leukemia. Epidemiology, etiology, pathophysiology and treatment. Mediterranean journal of hematology and infectious diseases, 2020. 12(1).
5. Döhner, H., E. Estey, D. Grimwade, S. Amadori, F.R. Appelbaum, T. Büchner, H. Dombret, B.L. Ebert, P. Fenaux, and R.A. Larson, Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. Blood, The Journal of the American Society of Hematology, 2017. 129(4): p. 424-447.
6. Ashman, L.K., P.A. Drew, I.R. Toogood, and C.A. Juttner, Immunological competence of patients in remission from acute leukaemia: apparently normal T cell function but defective pokeweed mitogen‐driven immunoglobulin synthesis. Immunology and cell biology, 1987. 65(2): p. 201-210.
7. Döhner, H., D.J. Weisdorf, and C.D. Bloomfield, Acute myeloid leukemia. New England Journal of Medicine, 2015. 373(12): p. 1136-1152.
8. van der Velden, W.J., A.H. Herbers, M.G. Netea, and N.M. Blijlevens, Mucosal barrier injury, fever and infection in neutropenic patients with cancer: introducing the paradigm febrile mucositis. British journal of haematology, 2014. 167(4): p. 441-452.
9. Escrihuela-Vidal, F., J. Laporte, A. Albasanz-Puig, and C. Gudiol, Update on the management of febrile neutropenia in hematologic patients. Revista Española de Quimioterapia, 2019. 32(Suppl 2): p. 55.
10. Orhan, B., F. Özkalemkaş, V. Özkocaman, B. Gürbüz, T. Ersal, İ.E. Pınar, C. Yalçin, Ö. Candar, S. Çubukçu, and T.G. Koca, The role of white blood cell count in perianal pathologies: A retrospective analysis of hematologic malignancies. Mediterranean Journal of Hematology and Infectious Diseases, 2022. 14(1).
11. Büyükaşık, Y., O.I. Özcebe, N. Sayınalp, I.C. Haznedaroğlu, Ö.Ö. Altundağ, O. Özdemir, and S. Dündar, Perianal infections in patients with leukemia: importance of the course of neutrophil count. Diseases of the colon & rectum, 1998. 41: p. 81-85.
12. Grewal, H., J.G. Guillem, S.H. Quan, W.E. Enker, and A.M. Cohen, Anorectal disease in neutropenic leukemic patients: operative vs. nonoperative management. Diseases of the colon & rectum, 1994. 37: p. 1095-1099.
13. Nada, E.M., A.N. Alshoaiby, A.S. Alaskar, and A.N. Khan, Severe anal and abdominal pain due to typhlitis in a leukemic patient. Journal of pain and symptom management, 2007. 34(5): p. 457-459.
14. Perazzoli, C., M.R. Feitosa, L.L.d. Figueiredo-Pontes, J.J.R.d. Rocha, B.P. Simões, and O. Féres, Management of acute colorectal diseases in febrile neutropenic patients. Journal of Coloproctology (Rio de Janeiro), 2014. 34: p. 189-192.
15. Solmaz, S., A. Korur, Ç. Gereklioğlu, S. Asma, N. Büyükkurt, M. Kasar, M. Yeral, İ. Kozanoğlu, C. Boğa, and H. Ozdoğu, Anorectal complications during neutropenic period in patients with hematologic diseases. Mediterranean journal of hematology and infectious diseases, 2016. 8(1).
16. Chang, H., M.-C. Kuo, T.-C. Tang, T.-L. Lin, J.-H. Wu, Y.-S. Hung, and P.-N. Wang, Clinical features and recurrence pattern of perianal abscess in patients with acute myeloid leukemia. Acta Haematologica, 2017. 138(1): p. 10-13.
17. Feng, J., W. Zhang, J. Wu, S. Gao, H. Ye, L. Sun, Y. Chen, K. Yu, and C.-Y. Xing, Effect of initial absolute monocyte count on survival outcome of patients with de novo non-M3 acute myeloid leukemia. Leukemia & Lymphoma, 2016. 57(11): p. 2548-2554.
18. Embaby, A., A. Fathy, M. Al-Akkad, A. Baraka, T. Ibrahim, N. Zidan, M. Refaat, and H. Elsheikh, Initial absolute monocyte count as an immune biomarker for clinical response in acute myeloid leukemia with monocytic differentiation. Journal of the Egyptian National Cancer Institute, 2020. 32(1): p. 1-11.
19. Rauch, P.J., J.M. Ellegast, C.C. Widmer, K. Fritsch, J.S. Goede, P.J. Valk, B. Löwenberg, H. Takizawa, and M.G. Manz, MPL expression on AML blasts predicts peripheral blood neutropenia and thrombocytopenia. Blood, The Journal of the American Society of Hematology, 2016. 128(18): p. 2253-2257.
20. Zhang, Q., K. Dai, L. Bi, S. Jiang, Y. Han, K. Yu, and S. Zhang, Pretreatment platelet count predicts survival outcome of patients with de novo non-M3 acute myeloid leukemia. PeerJ, 2017. 5: p. e4139.
21. Zein, J.G., G.L. Lee, M. Tawk, M. Dabaja, and G.T. Kinasewitz, Prognostic significance of elevated serum lactate dehydrogenase (LDH) in patients with severe sepsis. Chest, 2004. 126(4): p. 873S.
22. Lu, J., Z. Wei, H. Jiang, L. Cheng, Q. Chen, M. Chen, J. Yan, and Z. Sun, Lactate dehydrogenase is associated with 28-day mortality in patients with sepsis: a retrospective observational study. Journal of Surgical Research, 2018. 228: p. 314-321.
23. Huang, Z., W. Liu, Q. Guo, and C. Liu, Platelet parameters and expression of platelet membrane glycoprotein in childhood acute lymphoblastic leukemia. Genet Mol Res, 2015. 14(4): p. 16074-16089.
24. Balduini, C.L. and P. Noris, Mean platelet volume for distinguishing between inherited thrombocytopenias and immune thrombocytopenia–response to B eyan. British journal of haematology, 2013. 163(3): p. 413-414.
25. Chandra, H., S. Chandra, A. Rawat, and S. Verma, Role of mean platelet volume as discriminating guide for bone marrow disease in patients with thrombocytopenia. International journal of laboratory hematology, 2010. 32(5): p. 498-505.
26. Vinholt, P.J., A.M. Hvas, and M. Nybo, An overview of platelet indices and methods for evaluating platelet function in thrombocytopenic patients. European journal of haematology, 2014. 92(5): p. 367-376.
27. Zhang, S., Y.-L. Cui, M.-Y. Diao, D.-C. Chen, and Z.-F. Lin, Use of platelet indices for determining illness severity and predicting prognosis in critically ill patients. Chinese medical journal, 2015. 128(15): p. 2012-2018.
28. Golwala, Z.M., H. Shah, N. Gupta, V. Sreenivas, and J.M. Puliyel, Mean platelet volume (MPV), platelet distribution width (PDW), platelet count and Plateletcrit (PCT) as predictors of in-hospital paediatric mortality: a case-control study. African health sciences, 2016. 16(2): p. 356-362.
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