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Hypophosphatemia and hypouricemia in pediatric allogeneic bone marrow transplant recipients
Duygu Uçkan1, Mualla Cetin, Abdi Dida
1Bone Marrow Transplantation Unit, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey. duckan@hacettepe.edu.tr
Insights
Hypophosphatemia and hypouricemia are common after pediatric bone marrow transplants, linked to neutrophil recovery and platelet engraftment. Phosphate and uric acid levels reflect these complex recovery processes.
Area of Science:
- Hematology
- Biochemistry
- Pediatric Oncology
Background:
- Neutrophil phosphate uptake is implicated in hypophosphatemia (HP) post-bone marrow transplantation (BMT).
- Serum phosphate and uric acid (UA) levels may indicate neutrophil recovery and cytolysis, respectively.
Purpose of the Study:
- To investigate the relationship between serum phosphate levels and engraftment in pediatric BMT recipients.
- To analyze uric acid levels to assess the contribution of cytolysis to phosphate changes.
Main Methods:
- Serum phosphate and UA levels were monitored in 56 children undergoing allogeneic BMT.
- Engraftment (neutrophil and platelet) and nadir levels of phosphate and UA were analyzed relative to transplantation day.
Main Results:
- Hypophosphatemia (63%) and hypouricemia (57%) occurred frequently before day +20 post-BMT.
- Phosphate and UA nadirs occurred around day +10, preceding mean neutrophil engraftment at day +13.
- Significant correlations were found between phosphate and UA levels, and between platelet engraftment and phosphate levels.
Conclusions:
- Pediatric BMT patients frequently experience hypophosphatemia and hypouricemia.
- These electrolyte changes are associated with neutrophil recovery and platelet engraftment, reflecting complex pathophysiologic mechanisms.
Abstract:
Increased phosphate (P) uptake by the replicating neutrophils during engraftment syndrome has been described to play a role in the development of hypophosphatemia (HP) in bone marrow transplantation patients, and suggested as a measure of neutrophil recovery. Here, the relationship of serum P with engraftment was determined in 56 children who underwent allogeneic bone marrow transplantation (BMT). Uric acid (UA) levels were also analyzed to study the contribution of cytolysis on P levels. HP and hypouricemia (HU) developed at least once in 63 and 57% of patients respectively, before and until day +20 after transplantation. The minimal values of P and UA were observed at day +10 and were significantly lower than the baseline values (p < 0.01). The mean neutrophil engraftment was at day +13, following the P and UA nadir by 3 days. In addition there was a significant correlation between P and UA levels (p = 0.01). The levels of of both P and UA returned to pretransplant values at day +20. A significant correlation (p < 0.05) between platelet engraftment and P levels was also demonstrated. HP and HU seen in pediatric patients undergoing BMT reflects a combination of pathophysiologic mechanisms.