Hematologic Complication of Respiratory Virus Infection

In Ho Park; Su Ho Lee; Sung Taek You; Du Young Choi

doi:10.14776/kjpid.2013.20.3.178

Journal List > Korean J Pediatr Infect Dis > v.20(3) > 1096042

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Park, Lee, You, and Choi: Hematologic Complication of Respiratory Virus Infection

Original Article

Korean Journal of Pediatric Infectious Diseases 2013; 20(3): 178-185.

Published online: 26 December 2013

DOI: https://doi.org/10.14776/kjpid.2013.20.3.178

Hematologic Complication of Respiratory Virus Infection

In Ho Park, M.D., Su Ho Lee, M.D., Sung Taek You, M.D., Du Young Choi, M.D.

Department of Pediatrics, Wonkwang University College of Medicine, Iksan, Korea.

Corresponding author (cdy8118@wonkwang.ac.kr)

Received 3 February 2013 Revised 19 June 2013 Accepted 20 June 2013

Abstract

Objective

Cytopenia is a common hematologic complication of viral infections. However, information regarding hematologic effects of common respiratory virus infections is scarce. This study aimed to evaluate hematologic complications and the clinical course of patients infected with common respiratory viruses.

Methods

We retrospectively analyzed 496 patients with respiratory tract infections admitted to the Department of Pediatrics, Wonkwang University Hospital from November 2011 to March 2012 using multiplex real-time polymerase chain reaction to detect the presence of respiratory viruses and hematologic abnormalities.

Results

Respiratory viruses were identified in 379 patients. Respiratory syncytial virus (RSV) was most frequently detected (55.7%), followed by influenza A (Flu-A, 23.0%). Further, cytopenia was observed in 35.5% of RSV-infected patients, 25.0% of Flu-A-infected patients, and 34% of patients infected by other viruses. Each virus caused a decrease in 3 blood cell component values, which corresponded with cytopenia frequency. Of the 379 infected patients, 83 had anemia (9.71±1.09 g/dL); 46 had neutropenia (803.70±263.09 cells/mm³); and 23 had transient thrombocytopenia (142,434.78±86,835.18 cells/mm³). However, no patient required treatment. A comparison of clinical characteristics between RSV- and Flu-A-positive patients with anemia revealed that RSV-infected patients had significantly longer duration of hospitalization. RSV was detected more commonly in young neutropenic patients, who had a shorter duration of fever.

Conclusions

Our findings suggest that infections, particularly RSV and Flu-A, result in varying degrees of cytopenia, which usually improves without treatment and does not affect the clinical course of the infection.

Keywords: Respiratory viral infection, Cytopenia, Anemia, Neutropenia, Thrombocytopenia

Figures and Tables

Table 1

The Incidence of Respiratory Virus Infection with Hematologic Complication in Children with Respiratory Symptom

Abbreviations: RSV, respiratory syncytial virus; Flu-A, influenza virus A; Flu-B, influenza virus B; hRV, human rhinovirus; hCoV, human coronavirus; hMPV, human metapneumovirus; PIV, parainfluenza virus; AD, adenovirus.

Table 2

Clinical Characteristics and Hematologic Complication of the 379 Patients Hospitalized with the Respiratory Virus Infection

Values are mean±SD.

Table 3

Comparison of Clinical Charicteristics between RSV and Flu-A Infection on the Patients with Anemia

Abbreviations: RSV, respiratory syncytial virus; Flu-A, influenza virus A, Hb, hemoglobin.

Values are mean±SD.

Table 4

Comparison of Clinical Charicteristics between RSV and Flu-A Infection on the Patients with Neutropenia

Abbreviations: RSV, respiratory syncytial virus; Flu-A, influenza virus A, ANC; absolute neutrophil count.

Values are mean±SD.

Table 5

Comparison of Clinical Charicteristics between RSV and Flu-A Infection on the Patients with Thrombocytopenia

Abbreviations: RSV, respiratory syncytial virus; Flu-A, influenza virus A, PLT, platelet.

Values are mean±SD.

References

1. Jung BS, Oh JS, Cho B, Kim HH, Lee JS. A clinical study of respiratory tract infection. Pediatr Allergy Respir Dis. 1996; 6:60–63.

2. Elliot SP, Ray CG. Viral infections of the lower respiratory tract. In : Taussig LM, Landau LI, editors. Pediatric respiratory medicine. 2nd ed. Philadelphia: Mosby Elsevier Co;2008. p. 481–489.

3. Henrickson KJ, Hoover S, Kehl KS, Hua W. National disease burden of respiratory viruses detected in children by polymerase chain reaction. Pediatr Infect Dis J. 2004; 23:S11–S18.

4. Pettemore PK, Jennings LC. Epidemiology of respiratory infections. In : Taussig LM, Landau LI, editors. Pediatric respiratory medicine. 2nd ed. Philadelphia: Mosby Elsevier Co;2008. p. 435–452.

5. Choi EH, Lee HJ, Kim SJ, Eun BW, Kim NH, Lee JA, et al. The association of newly identified respiratory viruses with lower respiratory tract infections in Korean children, 2000-2005. Clin Infect Dis. 2006; 43:585–592.

6. Peter E. Leukopenia. In : Kliegman RM, Stanton BF, Schor NF, Behrman RE, St. Geme III JW, editors. Nelson textbook of pediatrics. 19th ed. Philadelphia: Elsevier Saunders;2011. p. 746–752.

7. Flaujac C, Boukour S, Cramer-Bordé E. Platelets and viruses: an ambivalent relationship. Cell Mol Life Sci. 2010; 67:545–556.

8. Ahn HS. Chapter 16. Hematologic disorders. In : Ahn HS, editor. Hong Changeui Textbook of Pediatrics. 10th ed. Seoul: Mirae-N Co., Ltd;2012. p. 753–754.

9. Wallach J. Interpretation of Diagnostic Tests. Philadephia: Little, Brown and Company (Inc.);2007. p. 8.

10. Centers for Disease Control and Prevention. Respiratory syncytial virus and parainfluenza virus surveillance-United States, 1989-90 season. MMWR Morb Mortal Wkly Rep. 1990; 39:832–833.

11. Lee SJ, Shin EW, Park EY, Oh PS, Kim KN, Yoon HS, et al. Epidemiology and clincal analysis of acute viral respiratory tract infections in children (September, 1998-May, 2003). Korean J Pediatr. 2005; 48:266–275.

12. Lee GR. The anemia of chronic disease. Semin Hematol. 1983; 20:61–80.

13. Fullerton HW. The iron-deficiency anemia of late infancy. Arch Dis Child. 1937; 12:91–94.

14. Yip R, Walsh KM, Goldfarb MG, Binkin NJ. Declining childhood anemia prevalence in a middle class setting; a pediatric success story? Pediatrics. 1987; 80:330–334.

15. Beigel WR. Trace elements in infectious processes. Med Clin North Am. 1976; 60:831–849.

16. Abshire TC, Reeves JD. Anemia of acute inflammation in children. J Pediatr. 1983; 103:868–871.

17. Han SH, Choi PH, Kim SK. Serum ferritin levels in patients with anemia related to acute infection and sequential changes of hemoglobin concentration. New Med J. 1989; 32:21–29.

18. Kim EA, Jung HL, Shim JY, Park JY, Park MS, Keum DH. An analysis of MCV, RDW, HDW and EPO concentration in anemia of acute infection. Korean J Pediatr Hematol Oncol. 2000; 7:16–23.

19. Segel GB, Halterman JS. Neutropenia in pediatric practice. Pediatr Rev. 2008; 29:12–23.

20. Capsoni F, Sarzi-Puttini P, Zanella A. Primary and secondary autoimmune neutropenia. Arthritis Res Ther. 2005; 7:208–214.

21. Palmblad J, Papadaki HA, Eliopoulos G. Acute and chronic neutropenias. What is new? J Intern Med. 2001; 250:476–491.

22. Consolini DM. Thrombocytopenia in infants and children. Pediatr Rev. 2011; 32:135–151.

23. Danon D, Jerushalmy Z, De Vries A. Incorporation of influenza virus in human blood platelets in vitro electron microscopical observation. Virology. 1959; 9:719–722.

24. Jerushalmy Z, Kohn A, De Vries A. Interaction of myxoviruses with human blood platelets in vitro. Proc Soc Exp Biol Med. 1961; 106:462–466.

25. Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010; 115:168–186.

26. Medeiros D, Buchanan GR. Current controversies in the management of idiopathic thrombocytopenic purpura during childhood. Pediatr Clin North Am. 1996; 43:757–772.

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