title: Investigation of hemophagocytic lymphohistiocytosis in severe sepsis patients.
abstract: Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening condition characterized by uncontrolled inflammation and has common clinical and laboratory features with sepsis. The aim of this study was to investigate patients treated with severe sepsis who had bicytopenia for the presence of HLH.
  
  
  
  Patients with severe sepsis who were non-responsive to treatment and developed at least bicytopenia were included. Peripheral blood samples were collected and stored for later evaluation for natural killer (NK) activity and soluble interleukin-2 receptor levels. Diagnostic criteria of HLH were retrospectively analyzed.
  
  
  
  Seventy-five of 382 patients (20%) were followed as severe sepsis and septic shock. Among them, 40 patients had bicytopenia. Twenty-six of 40 patients were excluded due to the presence of active solid or hematological malignancies. Three patients died before fulfillment of HLH criteria and one patient denied to give consent. All of the remaining 10 patients had at least five of the eight criteria according to criteria of the Histiocyte Society. Only one of 10 patients was diagnosed as HLH and received treatment during intensive care unit stay. None of the 10 patients survived.
  
  
  
  This study emphasizes to consider the possibility of HLH and the need of rapid assessment of patients with severe sepsis who had bicytopenia and were resistant to treatment in intensive care.
authors.affiliation: Hacettepe University Faculty of Medicine, Department of Internal Medicine, Medical Intensive Care Unit, Ankara, Turkey. Electronic address: burcin.halacli@yahoo.com.
authors.forename: Burcin
authors.initials: B
authors.lastname: Halacli
authors.affiliation: The University of Texas, MD Anderson Cancer Center, Houston, USA. Electronic address: unvernese@yahoo.com.
authors.forename: Nese
authors.initials: N
authors.lastname: Unver
authors.affiliation: Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Immunology, Ankara, Turkey. Electronic address: seviloskay@gmail.com.
authors.forename: Sevil Oskay
authors.initials: SO
authors.lastname: Halacli
authors.affiliation: Hacettepe University Faculty of Medicine, Department of Basic Oncology, Ankara, Turkey. Electronic address: hcanpina@hacettepe.edu.tr.
authors.forename: Hande
authors.initials: H
authors.lastname: Canpinar
authors.affiliation: Hacettepe University Faculty of Medicine, Department of Internal Medicine, Medical Intensive Care Unit, Ankara, Turkey. Electronic address: ebru.ortac@hacettepe.edu.tr.
authors.forename: Ebru Ortac
authors.initials: EO
authors.lastname: Ersoy
authors.affiliation: Hacettepe University Faculty of Medicine, Department of Internal Medicine, Medical Intensive Care Unit, Ankara, Turkey. Electronic address: drserpilgocmen@yahoo.com.
authors.forename: Serpil
authors.initials: S
authors.lastname: Ocal
authors.affiliation: Hacettepe University Faculty of Medicine, Department of Basic Oncology, Ankara, Turkey. Electronic address: dguc@hacettepe.edu.tr.
authors.forename: Dicle
authors.initials: D
authors.lastname: Guc
authors.affiliation: Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey. Electronic address: ybuyukas@hacettepe.edu.tr.
authors.forename: Yahya
authors.initials: Y
authors.lastname: Buyukasik
authors.affiliation: Hacettepe University Faculty of Medicine, Department of Internal Medicine, Medical Intensive Care Unit, Ankara, Turkey. Electronic address: atopeli@hacettepe.edu.tr.
authors.forename: Arzu
authors.initials: A
authors.lastname: Topeli
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007249:Inflammation / Q000473:pathology; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007694:Killer Cells, Natural / Q000166:cytology; D007902:Length of Stay; D051359:Lymphohistiocytosis, Hemophagocytic / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015375:Receptors, Interleukin-2 / Q000097:blood; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D015375:Receptors, Interleukin-2
keywords: Cytopenia; Hemophagocytosis; Interleukin-2 receptor; Natural killer; Sepsis