Hematological indices in pediatric patients with acyanotic congenital heart disease: a cross-sectional study of 248 patients

Hanieh Mohammadi; Behzad Mohammadpour Ahranjani; Ehsan Aghaei Moghadam; Farzad Kompani; Mona Mirbeyk; Nima Rezaei

doi:10.1186/s43042-022-00262-4

Hematological indices in pediatric patients with acyanotic congenital heart disease: a cross-sectional study of 248 patients

Egypt J Med Hum Genet. 2022;23(1):47. doi: 10.1186/s43042-022-00262-4. Epub 2022 Mar 8.

Authors

Hanieh Mohammadi¹, Behzad Mohammadpour Ahranjani², Ehsan Aghaei Moghadam³, Farzad Kompani⁴, Mona Mirbeyk⁵, Nima Rezaei^{5

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Affiliations

¹ Resident Research Committee, Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.
² Department of Pediatric Cardiology, Bahrami Children's Hospital, Tehran University of Medical Sciences, Tehran, Iran.
³ Pediatric Department, Children Medical Center, Pediatric and Adolescent Cardiovascular Research Center, Tehran University of Medical Sciences, Tehran, Iran.
⁴ Division of Hematology and Oncology, Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.
⁵ Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Dr Qarib St, Keshavarz Blvd, 14194 Tehran, Iran.
⁶ Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
⁷ Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.

Abstract

Background: Congenital heart disease CHD is a significant cause of mortality and morbidity in children worldwide. Patients with congenital heart disease may develop hematological problems, including thrombocytopenia and neutropenia. In addition, several studies indicate the higher frailty of patients with CHDs to infections and malignancies. Nevertheless, the mechanisms of immune system changes in these patients have remained in the shadow of uncertainty. Moreover, very few studies have worked on cytopenia in CHD. This study has assessed the frequency of thrombocytopenia, neutropenia, lymphopenia, and anemia in pediatric patients with acyanotic congenital heart disease ACHD prior to open-heart surgery.

Methods: This cross-sectional study was handled in the Pediatric Cardiology Clinic, Tehran University of Medical Sciences, during pre-operation visits from 2014 till 2019. Two hundred forty-eight children and adolescents with acyanotic congenital heart disease before open-heart surgery met the criteria to enter the study.

Results: A total of 191 (76.7%) patients with Ventricular Septal Defects (VSD), 37 (14.85%) patients with Atrial Septal Defects (ASD), and 20 (8.11%) patients with Patent Ductus Arteriosus (PDA) were enrolled in this study. The median age was 23.87 months. Thrombocytopenia and neutropenia were found, respectively, in 3 (1.2) and 23 (9.2%) patients. Hemoglobin level and lymphocyte count were significantly lower in patients with neutropenia than patients with normal neutrophil count (P value = 0.024 and P value = 0.000). Significant positive correlations were found between neutropenia and anemia. There were no correlations between neutrophil count and Platelets. Also, anemia was found in 48 patients (19.3%). The study also found a statistically significant correlation between the co-existence of VSD and neutropenia in the patients (P value = 0.000).

Conclusion: Although most were mildly neutropenic, there was a significant correlation between neutropenia and Ventricular Septal Defect compared to PDA and ASD groups. Regarding the importance of neutropenia to affect the prognosis of congenital heart defects in infections, it is important to consider further studies on the status of immune system function in these patients.

Keywords: Acyanotic congenital heart disease; Anemia; Congenital diseases; Neutropenia; Pediatrics.