Related Experiment Videos
Acute respiratory failure and pulmonary thrombosis in leukemic children
G Marraro1, C Uderzo, P Marchi
1Anaesthesia and Intensive Care Department, L. Mandic Hospital, Merate (CO), Italy.
Insights
Pulmonary thrombosis, a serious complication, can occur in children with acute leukemia (ALL/ANLL) during treatment. Early diagnosis and urokinase treatment with respiratory support offer a good prognosis for these patients.
Area of Science:
- Pediatric Oncology
- Hematology
- Pulmonology
Background:
- Acute respiratory failure (ARF) is a critical complication in pediatric leukemia patients.
- Pulmonary thrombosis is an underrecognized cause of ARF in this population, distinct from infectious origins.
Purpose of the Study:
- To investigate the occurrence and characteristics of pulmonary thrombosis in pediatric patients with acute lymphoblastic leukemia (ALL) and acute nonlymphoblastic leukemia (ANLL).
- To evaluate the diagnostic methods and treatment outcomes for this specific pulmonary complication.
Main Methods:
- Case report of an 11-year-old with pre-T ALL experiencing ARF due to pulmonary thrombosis.
- Systematic literature review identifying six additional pediatric cases with leukemia and pulmonary thrombosis.
- Diagnostic confirmation through arteriography and nuclear imaging.
- Review of treatment strategies including urokinase and respiratory support.
Main Results:
- Seven pediatric cases (ALL and ANLL) were identified with severe hypoxia and hypercapnia, minimal radiographic findings, and no clear hemodynamic involvement.
- Pulmonary thrombosis was confirmed as the cause of ARF.
- Potential causes include neoplastic emboli and therapy-induced vascular damage.
- Six of seven patients successfully responded to intravenous urokinase and respiratory assistance.
Conclusions:
- Pulmonary thrombosis is a significant cause of acute respiratory failure in children undergoing leukemia treatment.
- Early diagnosis via imaging is crucial.
- Treatment with urokinase and respiratory support can be effective, improving outcomes for affected children.
Abstract:
Acute respiratory failure (ARF) in an 11-year-old child with pre-T acute lymphoblastic leukemia (ALL) at the beginning of induction therapy was observed, connected with a pulmonary thrombosis and not with an infective origin. A systematic search for this pathology identified six other children with the same pulmonary complication, five of whom where in the early phase of acute nonlymphoblastic leukemia (ANLL) and one in induction therapy for ALL in marrow relapse. At the beginning of the symptomatology, all children presented severe hypoxia and hypercapnia, with no or minimal chest radiograph abnormalities and no clear hemodynamic involvement. In all patients the arteriography and nuclear imaging studies confirmed the diagnosis. The causes of the thrombi could be connected with neoplastic emboli after cell lysis and/or with the vascular damage resulting from antiblastic therapy. Intravenous urokinase treatment and respiratory assistance had been successfully carried out in six of seven children.