578
11.
12.
13.
14.
Clinical and laboratory observations
Stoler MH. Bacillary angiomatosis: the histopathology and differential diagnosis of a pseudoneoplastic infection in patients with human immunodeficiency virus disease. Am J Surg Pathol 1989;13:909-20. Cockerell CJ, Bergstresser PR, Myrie-WilliamsC, Tierno PM. Bacillary epithelioid angiomatosis occurring in an immunocompetent individual. Arch Dermatol 1990;126:787-90. Cockerell C J, Tierno PM, Friedman-Kien AE, Kim KS. Clinical, histologie, microbiologic, and biochemical characterization of the causative agent of bacillary (epithelioid) angiomatosis: a rickettsial illness with features of bartonellosis. J Invest Dermatol 1991 ;97:812-7. Birtles R J, Harrison TG, Taylor AG. The causative agent of bacillary angiomatosis [Letter]. N Engl J Med 1991;325: 1447. Relman DA, Falkow S, Leboit PE, et al. The organism caus-
The Journal of Pediatrics October 1992
15.
16.
17.
18.
ing bacillary angiomatosis, peliosis hepatis, and fever and bacteremia in immunocompromised patients [Letter]. N Engl J Med 1991;324:1514. Lucey D, Dolan M J, Moss CW, et al. Relapsing illness due to Rochalimaea henselae in immunocompetent hosts: implication for therapy and new epidemiological associations. Clin Infect Dis 1992;14:683-8. Tappero JW, Mohle-Boetani J, Koehler J, et al. The epidemiology of bacillary angiomatosis [Abstract]. J Invest Dermatol 1992;98:567. Pembroke AC, Grice K, Levantine AV, Warin AP. Eruptive angiomata in malignant disease. Clin Exp Dermatol 1978;3: t47-56. Omura EF, Omura GA. Human immunodeficiencyvirus-associated skin lesions [Letter]. JAMA 1989;261:991.
Erythrocyte macrocytosis in infants and children with Down syndrome T h o m a s J. S t a r c , MD From the Division of Pediatric Cardiology, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York
Erythrocyte mean corpuscular volume and mean corpuscular hemoglobin levels were higher in children with Down syndrome than in normal control subjects. Reference values for mean corpuscular volume and mean corpuscular hemoglobin level derived from normal populations may be inappropriate for children with Down syndrome. These findings may have important implications for the diagnosis of iron deficiency in these children. (J PEDIATR1992;121:578-81)
Several investigators have reported erythrocyte macrocytosis in adults 1-5 and children 6, ~ with Down syndrome; however, one group reported no statistically significant increase in erythrocyte size in infants with Down syndrome. 6 The purpose of this study was to assess possible abnormalities in erythrocyte size, as well as other hematologic indexes, in young patients with Down syndrome. Because many of the children with Down syndrome in this study also had heart disease, they were compared with both normal children and children with congenital heart disease.
Submitted for publication Dec. 19, 1991; accepted April 9, 1992. Reprint requests: Thomas J. Starc, MD, Columbia University, Division of Pediatric Cardiology, 630 West 168th St., Babies Hospital, Room 102A South, New York, NY 10032.
9/22/38567
METHODS
Patient population Down syndrome. Sixty-three children with Down syndrome were retrospectively identified from hospital records between January 1986 and February 1990. The diagnosis was confirmed by review of the patient's chart or by interview with the patient's physician. The mean age of the children was 2.1 years and ranged from 0.33 to 6.33 years. Fifty-two children with Down syndrome had congenital heart disease, and 11 had no heart disease. Normal control group. The normal control group consisted of 196 normal children without heart disease between 0.36 and 6.8 years of age who received their primary care in a pediatric clinic in our institution. Children with chronic illnesses and those who had been treated for anemia were excluded~ Cardiac control group. The normal control group con-
Volume 121 Number 4
Clinical and laboratory observations
5 79
Table. Hematologic data in three groups studied Infants 3 m o to 2 yr of a g e
Age (yr) Erythrocytes (109/L) Hemoglobin (gm/dl) Hematocrit (%) MCV (fl) MCH (pg) MCHC (gm/dl)
DS (n = 33)
Normal (n = 404)
0.9 _+ 0.5 4.4 + 0.4 12.8 + 1.0 38.4 + 3.2 87.9 _+ 6.0 29.5 • 2.0 33.4 • 0.9
1.1 _+ 0.4 4.5 + 0.3 12.1 • 0.8* 35.7 • 2.2* 78.6 + 4.4* 26.6 • 2.0* 33.9 • 1.0
Children 2 to 7 yr of a g e
Cardiac (n = 25)
1.0 + 4.6 • 12.5 • 36.8 + 80.8 • 27.5 • 33.9 •
0.3 0.4 0.8 2.9 5.3~ 2.0t 1.1
DS (n = 44)
Normal (n = 95)
Cardiac (n = 33)
4.0 --+ 1.I 4.3 _+ 0.1 12.9 _+ 0.8 38.8 _+ 1.7 89.6 _+ 3.4 29.9 + 1.5 33.3 • 0.7
3.8 • 1.2 4.4 _+ 0.3 12.1 _+ 0.6* 36.0 --+ 1.7" 81.0 + 4.5* 27.6 + 1.9" 33.3 -+ 3.6
4.0 __+1.2 4.5 _ 0.4 12.7 + 0.9 37.6 _+ 2.9 82.4 _+ 4.2t 28.3 ___2.0r 33.1 • 0.8
DS, Downsyndrome;MCHC, meancorpuscularhemoglobinconcentration. *p __90ft, which exceeded the mean +2 SD for children in the
normal control group and is consistent with findings published by others, s Comparisons in the incidence of macrocytosis between children with Down syndrome and the control groups were made with the chi-square test. Differences were considered significant if p < 0.05. RESULTS Infants. The mean erythrocyte MCV was larger in infants with Down syndrome than in the normal control group and and in the cardiac control group (p
11.
12.
13.
14.
Clinical and laboratory observations
Stoler MH. Bacillary angiomatosis: the histopathology and differential diagnosis of a pseudoneoplastic infection in patients with human immunodeficiency virus disease. Am J Surg Pathol 1989;13:909-20. Cockerell CJ, Bergstresser PR, Myrie-WilliamsC, Tierno PM. Bacillary epithelioid angiomatosis occurring in an immunocompetent individual. Arch Dermatol 1990;126:787-90. Cockerell C J, Tierno PM, Friedman-Kien AE, Kim KS. Clinical, histologie, microbiologic, and biochemical characterization of the causative agent of bacillary (epithelioid) angiomatosis: a rickettsial illness with features of bartonellosis. J Invest Dermatol 1991 ;97:812-7. Birtles R J, Harrison TG, Taylor AG. The causative agent of bacillary angiomatosis [Letter]. N Engl J Med 1991;325: 1447. Relman DA, Falkow S, Leboit PE, et al. The organism caus-
The Journal of Pediatrics October 1992
15.
16.
17.
18.
ing bacillary angiomatosis, peliosis hepatis, and fever and bacteremia in immunocompromised patients [Letter]. N Engl J Med 1991;324:1514. Lucey D, Dolan M J, Moss CW, et al. Relapsing illness due to Rochalimaea henselae in immunocompetent hosts: implication for therapy and new epidemiological associations. Clin Infect Dis 1992;14:683-8. Tappero JW, Mohle-Boetani J, Koehler J, et al. The epidemiology of bacillary angiomatosis [Abstract]. J Invest Dermatol 1992;98:567. Pembroke AC, Grice K, Levantine AV, Warin AP. Eruptive angiomata in malignant disease. Clin Exp Dermatol 1978;3: t47-56. Omura EF, Omura GA. Human immunodeficiencyvirus-associated skin lesions [Letter]. JAMA 1989;261:991.
Erythrocyte macrocytosis in infants and children with Down syndrome T h o m a s J. S t a r c , MD From the Division of Pediatric Cardiology, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York
Erythrocyte mean corpuscular volume and mean corpuscular hemoglobin levels were higher in children with Down syndrome than in normal control subjects. Reference values for mean corpuscular volume and mean corpuscular hemoglobin level derived from normal populations may be inappropriate for children with Down syndrome. These findings may have important implications for the diagnosis of iron deficiency in these children. (J PEDIATR1992;121:578-81)
Several investigators have reported erythrocyte macrocytosis in adults 1-5 and children 6, ~ with Down syndrome; however, one group reported no statistically significant increase in erythrocyte size in infants with Down syndrome. 6 The purpose of this study was to assess possible abnormalities in erythrocyte size, as well as other hematologic indexes, in young patients with Down syndrome. Because many of the children with Down syndrome in this study also had heart disease, they were compared with both normal children and children with congenital heart disease.
Submitted for publication Dec. 19, 1991; accepted April 9, 1992. Reprint requests: Thomas J. Starc, MD, Columbia University, Division of Pediatric Cardiology, 630 West 168th St., Babies Hospital, Room 102A South, New York, NY 10032.
9/22/38567
METHODS
Patient population Down syndrome. Sixty-three children with Down syndrome were retrospectively identified from hospital records between January 1986 and February 1990. The diagnosis was confirmed by review of the patient's chart or by interview with the patient's physician. The mean age of the children was 2.1 years and ranged from 0.33 to 6.33 years. Fifty-two children with Down syndrome had congenital heart disease, and 11 had no heart disease. Normal control group. The normal control group consisted of 196 normal children without heart disease between 0.36 and 6.8 years of age who received their primary care in a pediatric clinic in our institution. Children with chronic illnesses and those who had been treated for anemia were excluded~ Cardiac control group. The normal control group con-
Volume 121 Number 4
Clinical and laboratory observations
5 79
Table. Hematologic data in three groups studied Infants 3 m o to 2 yr of a g e
Age (yr) Erythrocytes (109/L) Hemoglobin (gm/dl) Hematocrit (%) MCV (fl) MCH (pg) MCHC (gm/dl)
DS (n = 33)
Normal (n = 404)
0.9 _+ 0.5 4.4 + 0.4 12.8 + 1.0 38.4 + 3.2 87.9 _+ 6.0 29.5 • 2.0 33.4 • 0.9
1.1 _+ 0.4 4.5 + 0.3 12.1 • 0.8* 35.7 • 2.2* 78.6 + 4.4* 26.6 • 2.0* 33.9 • 1.0
Children 2 to 7 yr of a g e
Cardiac (n = 25)
1.0 + 4.6 • 12.5 • 36.8 + 80.8 • 27.5 • 33.9 •
0.3 0.4 0.8 2.9 5.3~ 2.0t 1.1
DS (n = 44)
Normal (n = 95)
Cardiac (n = 33)
4.0 --+ 1.I 4.3 _+ 0.1 12.9 _+ 0.8 38.8 _+ 1.7 89.6 _+ 3.4 29.9 + 1.5 33.3 • 0.7
3.8 • 1.2 4.4 _+ 0.3 12.1 _+ 0.6* 36.0 --+ 1.7" 81.0 + 4.5* 27.6 + 1.9" 33.3 -+ 3.6
4.0 __+1.2 4.5 _ 0.4 12.7 + 0.9 37.6 _+ 2.9 82.4 _+ 4.2t 28.3 ___2.0r 33.1 • 0.8
DS, Downsyndrome;MCHC, meancorpuscularhemoglobinconcentration. *p __90ft, which exceeded the mean +2 SD for children in the
normal control group and is consistent with findings published by others, s Comparisons in the incidence of macrocytosis between children with Down syndrome and the control groups were made with the chi-square test. Differences were considered significant if p < 0.05. RESULTS Infants. The mean erythrocyte MCV was larger in infants with Down syndrome than in the normal control group and and in the cardiac control group (p
