title: Paroxysmal nocturnal hemoglobinuria in pediatric patients.
abstract: BACKGROUND
  Paroxysmal nocturnal hemoglobinuria (PNH) is a rare disease in children. The most significant clinical features of PNH include: bone marrow failure, intravascular hemolysis, and thrombosis. To further characterize the clinical presentation and outcome to treatment we performed a retrospective analysis of pediatric patients with PNH.
  
  
  METHODS
  We reviewed the medical records of 12 consecutive pediatric patients with PNH diagnosed at our institution from 1992 to 2010.
  
  
  RESULTS
  Presenting clinical symptoms included: bone marrow failure (N = 10); gross hemoglobinuria with isolated red cell anemia (N = 1); and jaundice, hepatitis, and isolated thrombocytopenia (N = 1). Immunosuppressive therapy was the initial treatment for 8 patients. Five patients had myelodysplastic features without developing excessive blasts or leukemic transformation. Thrombosis occurred in 6 patients. Five patients underwent hematopoietic stem cell transplant (HSCT) of whom 3 patients are alive and disease-free. Three patients received anti-complement therapy with eculizumab. Two patients died following complications related to thrombosis and 2 patients are transfusion independent with stable disease.
  
  
  CONCLUSIONS
  This report highlights a high rate of bone marrow failure along with a low rate of hemoglobinuria at presentation, a high rate of thrombosis, and for some patients the spontaneous resolution of myelodysplastic features. Delay in diagnosis is common and we recommend appropriate PNH testing in all patients with AA, MDS, unexplained Coombs-negative hemolysis, or thrombosis. While HSCT remains the only curative option the high prevalence of hemolysis and thrombosis should warrant the consideration of early treatment with anti-complement therapy.
authors.affiliation: Department of Pediatrics, Memorial Sloan-Kettering Cancer Center-Bone Marrow Transplant Service, New York, New York, USA.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Curran
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Kernan
authors.forename: Susan E
authors.initials: SE
authors.lastname: Prockop
authors.forename: Andromachi
authors.initials: A
authors.lastname: Scaradavou
authors.forename: Trudy N
authors.initials: TN
authors.lastname: Small
authors.forename: Rachel
authors.initials: R
authors.lastname: Kobos
authors.forename: Hugo
authors.initials: H
authors.lastname: Castro-Malaspina
authors.forename: David
authors.initials: D
authors.lastname: Araten
authors.forename: Donna
authors.initials: D
authors.lastname: DiMichele
authors.forename: Richard J
authors.initials: RJ
authors.lastname: O'Reilly
authors.forename: Farid
authors.initials: F
authors.lastname: Boulad
mesh_terms: D000293:Adolescent; D000740:Anemia / Q000209:etiology; D001853:Bone Marrow / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006457:Hemoglobinuria, Paroxysmal / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D006461:Hemolysis; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology
chemical_list: D007166:Immunosuppressive Agents