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Pulmonary thromboembolism in leukaemic children undergoing bone marrow transplantation
1Department of Pediatric Haematology Oncology, Gerardo Hospital, Monza, University of Milan, Italy.
Insights
Pulmonary thromboembolism (PTE) is a serious complication in children undergoing bone marrow transplantation (BMT). Early diagnosis and treatment with urokinase and heparin can be successful in managing this condition.
Area of Science:
- Hematology
- Pulmonology
- Critical Care Medicine
Background:
- Bone marrow transplantation (BMT) is a life-saving procedure for children with leukemia.
- Early pulmonary complications can arise post-BMT, necessitating prompt diagnosis and management.
Observation:
- Three out of 67 pediatric leukemia patients developed severe acute respiratory syndrome within one month of BMT.
- These cases were associated with pulmonary thromboembolism (PTE), diagnosed via scintiscan and/or angiography.
Findings:
- Successful intervention was achieved in two patients using continuous positive pressure ventilation, urokinase, and heparin.
- Urokinase was administered as a loading dose followed by continuous infusion for 12-18 hours.
- Heparin was given as a continuous infusion for an average of 10 days.
Implications:
- Pulmonary thromboembolism (PTE) should be strongly considered in pediatric BMT patients presenting with early pulmonary complications.
- While the exact pathogenesis of PTE in this context remains unclear, urokinase therapy shows promise in reducing early morbidity.
Abstract:
Of 67 leukaemic children transplanted in our BMT unit 3 presented with severe acute respiratory syndrome associated with pulmonary thromboembolism (PTE) as diagnosed by scintiscan and/or angiography in the first month after BMT. Intervention with continuous positive pressure ventilation, urokinase (loading dose, then continuous infusion for 12-18 h) and heparin (continuous infusion for an average of 10 days) has been carried out successfully in two cases. In conclusion, when evaluating patients undergoing BMT and developing early pulmonary complications, PTE must be considered. The pathogenesis of PTE is still difficult to ascertain but urokinase therapy may reduce early morbidity.