HIGH FERRITIN LEVELS IN FEVER OF UNKNOWN ORIGIN: POSSIBLE FIRST SIGN OF HEMOPHAGOCYTOSIS IN BMT PATIENTS ?
(Abstract release date: 05/19/16)
EHA Library. Yaman Y. 06/09/16; 135064; PB2164
Dr. Yöntem Yaman
Contributions
Contributions
Abstract
Abstract: PB2164
Type: Publication Only
Background
Fever of unknown origin is a major problem in transplant patients. The management of prolonged fever without any signs and symptoms of a specific microorganism such as bacteria, virus or molds is controversial and debateful.
Aims
While checking other biological parameters of FUO, we also included ferritin to rule out hemophagocytosis.
Methods
Between January 2015-February 2016 out of 37 allogeneic transplantations ( 21 MFD, 3 haploidentical, 12 MUD, 1 cord blood), 6 patients ( 4 girls/2 boys, 3 MFD/ 3 MUD, 2 malignant diseases/ 4 nonmalignant disease) developed high fever with hepatosplenomegaly at median day 28 (14-45 days ). They were treated with broad spectrum antibiotics, they were all receiving prophylactic viral treatment with acyclovir and prophylactic flucanozol . No microbiological agent causing the fever could be detected. In patients with fever more than 5 days, CT scan of the chest, abdominal ultrasonography were performed, without any diagnostic findings. At the onset of fever none of the patients had GvHD.
Results
The ferritin levels of these patients were found to be very high ( median 93.486 ng/ml, 3587-381.300 ng/ml) Other major parameters of hemophagocytosis such as hypertriglyceridemia, pancytopenia etc were not detected. The patients were treated with steroids and fever resolved in all patients within 48 hours. One patient died of graft rejection, one patient received steroid and plasma exchange due to severe multiorgan dysfunction. They received steroids for a median of 29,5 days ( 24-34 days ).
Conclusion
In transplant patients fever can be sometimes very hard to manage. If a microbiological cause of fever could not be detected we think that checking the ferritin level is very important, even if some of the diagnostic parameters for hemophagocytosis are missing. High ferritin levels could be the first sign of hemophagocytosis in these patients and it can be treated with steroids excluding etoposide to secure the graft.
Session topic: E-poster
Keyword(s): Ferritin, Fever
Type: Publication Only
Background
Fever of unknown origin is a major problem in transplant patients. The management of prolonged fever without any signs and symptoms of a specific microorganism such as bacteria, virus or molds is controversial and debateful.
Aims
While checking other biological parameters of FUO, we also included ferritin to rule out hemophagocytosis.
Methods
Between January 2015-February 2016 out of 37 allogeneic transplantations ( 21 MFD, 3 haploidentical, 12 MUD, 1 cord blood), 6 patients ( 4 girls/2 boys, 3 MFD/ 3 MUD, 2 malignant diseases/ 4 nonmalignant disease) developed high fever with hepatosplenomegaly at median day 28 (14-45 days ). They were treated with broad spectrum antibiotics, they were all receiving prophylactic viral treatment with acyclovir and prophylactic flucanozol . No microbiological agent causing the fever could be detected. In patients with fever more than 5 days, CT scan of the chest, abdominal ultrasonography were performed, without any diagnostic findings. At the onset of fever none of the patients had GvHD.
Results
The ferritin levels of these patients were found to be very high ( median 93.486 ng/ml, 3587-381.300 ng/ml) Other major parameters of hemophagocytosis such as hypertriglyceridemia, pancytopenia etc were not detected. The patients were treated with steroids and fever resolved in all patients within 48 hours. One patient died of graft rejection, one patient received steroid and plasma exchange due to severe multiorgan dysfunction. They received steroids for a median of 29,5 days ( 24-34 days ).
Conclusion
In transplant patients fever can be sometimes very hard to manage. If a microbiological cause of fever could not be detected we think that checking the ferritin level is very important, even if some of the diagnostic parameters for hemophagocytosis are missing. High ferritin levels could be the first sign of hemophagocytosis in these patients and it can be treated with steroids excluding etoposide to secure the graft.
Session topic: E-poster
Keyword(s): Ferritin, Fever
Abstract: PB2164
Type: Publication Only
Background
Fever of unknown origin is a major problem in transplant patients. The management of prolonged fever without any signs and symptoms of a specific microorganism such as bacteria, virus or molds is controversial and debateful.
Aims
While checking other biological parameters of FUO, we also included ferritin to rule out hemophagocytosis.
Methods
Between January 2015-February 2016 out of 37 allogeneic transplantations ( 21 MFD, 3 haploidentical, 12 MUD, 1 cord blood), 6 patients ( 4 girls/2 boys, 3 MFD/ 3 MUD, 2 malignant diseases/ 4 nonmalignant disease) developed high fever with hepatosplenomegaly at median day 28 (14-45 days ). They were treated with broad spectrum antibiotics, they were all receiving prophylactic viral treatment with acyclovir and prophylactic flucanozol . No microbiological agent causing the fever could be detected. In patients with fever more than 5 days, CT scan of the chest, abdominal ultrasonography were performed, without any diagnostic findings. At the onset of fever none of the patients had GvHD.
Results
The ferritin levels of these patients were found to be very high ( median 93.486 ng/ml, 3587-381.300 ng/ml) Other major parameters of hemophagocytosis such as hypertriglyceridemia, pancytopenia etc were not detected. The patients were treated with steroids and fever resolved in all patients within 48 hours. One patient died of graft rejection, one patient received steroid and plasma exchange due to severe multiorgan dysfunction. They received steroids for a median of 29,5 days ( 24-34 days ).
Conclusion
In transplant patients fever can be sometimes very hard to manage. If a microbiological cause of fever could not be detected we think that checking the ferritin level is very important, even if some of the diagnostic parameters for hemophagocytosis are missing. High ferritin levels could be the first sign of hemophagocytosis in these patients and it can be treated with steroids excluding etoposide to secure the graft.
Session topic: E-poster
Keyword(s): Ferritin, Fever
Type: Publication Only
Background
Fever of unknown origin is a major problem in transplant patients. The management of prolonged fever without any signs and symptoms of a specific microorganism such as bacteria, virus or molds is controversial and debateful.
Aims
While checking other biological parameters of FUO, we also included ferritin to rule out hemophagocytosis.
Methods
Between January 2015-February 2016 out of 37 allogeneic transplantations ( 21 MFD, 3 haploidentical, 12 MUD, 1 cord blood), 6 patients ( 4 girls/2 boys, 3 MFD/ 3 MUD, 2 malignant diseases/ 4 nonmalignant disease) developed high fever with hepatosplenomegaly at median day 28 (14-45 days ). They were treated with broad spectrum antibiotics, they were all receiving prophylactic viral treatment with acyclovir and prophylactic flucanozol . No microbiological agent causing the fever could be detected. In patients with fever more than 5 days, CT scan of the chest, abdominal ultrasonography were performed, without any diagnostic findings. At the onset of fever none of the patients had GvHD.
Results
The ferritin levels of these patients were found to be very high ( median 93.486 ng/ml, 3587-381.300 ng/ml) Other major parameters of hemophagocytosis such as hypertriglyceridemia, pancytopenia etc were not detected. The patients were treated with steroids and fever resolved in all patients within 48 hours. One patient died of graft rejection, one patient received steroid and plasma exchange due to severe multiorgan dysfunction. They received steroids for a median of 29,5 days ( 24-34 days ).
Conclusion
In transplant patients fever can be sometimes very hard to manage. If a microbiological cause of fever could not be detected we think that checking the ferritin level is very important, even if some of the diagnostic parameters for hemophagocytosis are missing. High ferritin levels could be the first sign of hemophagocytosis in these patients and it can be treated with steroids excluding etoposide to secure the graft.
Session topic: E-poster
Keyword(s): Ferritin, Fever
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