Treatment of metabolic abnormalities with rasburicase in a premature neonate
##plugins.themes.bootstrap3.article.main##
##plugins.themes.bootstrap3.article.sidebar##
Abstract
Transient leukemoid reactions are well-documented in the neonatal intensive care unit, however, hyperleukocytosis greater than 100 x 109/L remains a rare entity in premature neonates. We report the development of extreme hyperleukocytosis in an extremely low birth weight premature neonate born at 24-2/7 weeks of gestational age due to premature rupture of membranes in a mother who had received antenatal corticosteroids. The patient subsequently developed gross dyselectrolytemia similar to tumor lysis syndrome. Infectious workup remained unrevealing, flow cytometry of the peripheral blood showed no immunophenotypic evidence of acute leukemia, and a normal female XX karyotype was confirmed. A single dose of rasburicase was administered, with rapid and safe resolution of hyperuricemia, allowing for maintenance of kidney function. The patient was treated for presumed sepsis, although cultures remained negative. The white blood cell count gradually normalized over the first two weeks of life. The patient required treatment for a patent ductus arteriosus and was severely ventilator dependent for 33 days post-partum. To our knowledge, this is the first documented case wherein electrolyte abnormalities similar to those seen in tumor lysis syndrome had complicated the course of a leukemoid reaction in an extremely premature neonate necessitating the use of rasburicase
##plugins.themes.bootstrap3.article.details##
hyperleukocytosis, transient leukemoid reaction, premature infants, rasburicase, tumor lysis syndrome, extreme prematurity, extremely low birth weight
2. Jansen E, Emmen J, Mohns T, Donker A. Extreme hyperleucocytosis of the premature. BMJ Case Rep 2013; 2013. Pii:bcr2012008385.
3. Ava Bratha K, Tauro K, Sheshadri G, Sushanth. Hyperleukocytosis in a neonate: a diagnostic dilemma. Indian J Med Paediatr Oncol 2010; 31(3):132.
4. Isik D, Aydemir O, Kale Y et al. Severe leukemoid reaction in a preterm infant with congenital Cytomegalovirus infection. J Pediatr Hematol Oncol 2014; 36(5):e310-e312.
5. Kato K, Matsui K, Hoshino M et al. Tumor cell lysis syndrome resulting from transient abnormal myelopoiesis in a neonate with Down's syndrome. Pediatr Int 2001; 43(1):84-86.
6. Underwood M, Wartell A, Borghese R. Hyperleukocytosis in a premature infant with intrauterine herpes simplex encephalitis. J Perinatol 2012; 32(6):469-472.
7. Hoff D. Suspected betamethasone-induced leukemoid reaction in a premature infant. Pharmacotherapy 2016; 17(5):1031-1033.
8. Iwatani S, Mizobuchi M, Sofue T, et al. Neonatal leukemoid reaction associated with Candida albicans chorioamnionitis. Pediatr Int 2014; 56(2):277-279.
9. Kumar A, Kumar P, Basu S. Enterococcus fecalis sepsis and leukemoid reaction. J Pediatr Hematol Oncol 2015; 37(7):e419-e420.
10. Calhoun D, Kirk J, Christensen R. Incidence, significance, and kinetic mechanism responsible for leukemoid reactions in patients in the neonatal intensive care unit: a prospective evaluation. J Pediatr, 1996; 129(3):403-409.
11. Rastogi S, Rastogi D, Sundaram R, Kulpa J, Parekh A. Leukemoid reaction in extremely low-birth-weight infants. Am J Perinatol 1999; 16(02):93-97.
12. Hsiao R. Outcome of extremely low birth weight infants with leukemoid reaction. Pediatrics 2005; 116(1):e43-e51.
13. Zanardo V, Magarotto M, Rosolen A. Neonatal leukemoid reaction and early development of bronchopulmonary dysplasia in a very low-birth-weight infant. Fetal Diagn Ther 2001; 16(3):150-152.
14. Boesveld M, Hemels M. Discordant transient extreme hyperleukocytosis in dichorionic diamniotic twins. J Pediatr Hematol Oncol 2016; 38(3):246-247.
15. McNutt D. Rasburicase for the management of tumor lysis syndrome in neonates. Ann Pharmacother 2006; 40(7):1445-1450.
16. Ghirardello S, Ardissino G, Mastrangelo A, Mosca F. Rasburicase in the treatment of hyperuricemia of newborns. Pediatr Nephrol 2010; 25(9):1775-1775.
17. Zaramella P, De Salvia A, Zaninotto M, et al. Lethal effect of a single dose of rasburicase in a preterm newborn infant. Pediatrics 2012; 131(1):e309-e312.
Archive of Clinical Cases is protected by copyright and may be used in accordance with copyright and other applicable laws. Content available at www.clinicalcases.eu and our digital applications is intended for personal noncommercial use.
Authors who submit a manuscript for publication in Archive of Clinical Cases agree to the following terms: a. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. b. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. c. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) only after the final version of the manuscript was accepted and published, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access). d. It is compulsory that before submission authors ensure that their work was not published in any other medical journals or pending acceptance for publication and that "Archives of Clinical Cases" is the only beneficiary at that moment if their work/case will be accepted by us.
Guidelines for linking to www.clinicalcases.eu a. The main purpose of the site linking to the Archive of Clinical Casess site should be educational. b. Links should be made to the Archive of Clinical Casess home page (www.clinicalcases.eu) or to the articles abstract. c. It is forbidden to use the Archive of Clinical Casess cover by outside organizations unless permission has been granted in advance, notifying our Secretary. d. Material owned by the Archive of Clinical Cases (including the name, logo, cover, and text) may not be used in any manner that may induce the idea or suggest that the Archive of Clinical Cases is in some way recommending a specific company, product or service. e. You must not use or allow others to access or use, all or any part of our Site or the contents and/or applications on it for commercial purposes without our permission. To seek permission to do anything prohibited by or not contained in these TERMS, or which requires our prior consent or agreement, you can contact us.