الفهرس 
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Abstract
In childhood cancers, severe and prolonged neutropenia develops in
association with the use of intensive chemotherapy protocols, which
results in the onset of infections with potentially higher rates of morbidity
and mortality. In childhood cancer, mortality rates associated with febrile
neutropenia have decreased in recent years but not to desired levels.
Despite all of these biomarkers, severity of infection and risk of
mortality cannot be fully determined. Therefore, new biomarkers have
been investigated. As a new biomarker, the predictive and prognostic
values of adrenomedullin in pulmonary, cardiovascular, and
rheumatological diseases have been reported.
The aim of this study is to evaluate the importance of serum
adrenomedullin levels in diagnosis of febrile neutropenia in pediatric
patients with malignancy.
This study comprised 25 patients admitted to the Hematology
and Oncology Unit, Menoufia University Hospital, diagnosed as acute
lymphoblastic leukemia and have episode of febrile neutropenia.
These patients were 15 males and 10 females with a mean± SD
(4.79 ±3.81)age ranging from 1-14 years. In each episode of FN,
complete history taking and careful physical examination were done with
particular attention to areas that may hide a site of infection unless closely
examined particularly the oral cavity and the perianal area.
The following laboratory parameters were done in each attack of
FN :
a) Complete blood picture with differential count.
b) C-reactive protein level in 1st and 5th day.
90
c) Blood culture for both bacteria and fungi.
d) Adrenomedallin level in 1st and 5th day.
e) Chest x-ray.
f) Lab. function (Na, K, SGPT, Creatinine level).
Patients were 15 males and 10 females with a age ranging from
1-14 (mean ± SD ) (4.79 ± 3.81).
All of cases where presented with chest infection (pneumonia) and 14
(56%) of their X-ray showing pneumonia while the other 11(44%) showed
nothing.
Regarding the organisms Causing infection in Febrile Neutropenic
attack, 17(68%) were G-ve bacilli while 8(32%) were fungal infection,
(62%) were Aspergillus spp & (38%) were candida.
Neutrophils, platelets and WBS were increase in 5th day than 1st day
(p.value >0.001), while in HG had no significantly difference between 1st
and 5th day of febrile neutropenia (p.value < 0.05). There was no
significant changes in level of Na, K, Creatinine and SGPT in 1st and 5th
day of febrile neutropenia, (P.value <0.05).
Adrenomedallin was significantly higher in 5th day than 1st day of
febrile neutropenia (P.value <0.001), but CRP was significantly lower in
5th day than 1st day of febrile neutropenia (P.value < 0.05).
There was no significant correlation between CRP or adrenomedallin
VS days of neutropenia or type of culture (p.value <0.05).
Adrenomedallin was more sensitive (93.33%) than CRP (80%) in
febrile neutropenic episode. As regarding the specificity of the markers in
FN, the Adrenomedallin was more specific (85.4%) than CRP (73%). The
ROC curve also showed that the positive predictive value (PPV) of
91
Adrenomedallin in this study was (90%) which was higher than the PPV
of CRP (89%). The area under the curve (AUC) in Adrenomedallin was
(0.94) while in CRP was (0.76).
There was no significant correlation between CRP VS
Adrenomedallin in 1st or 5th day of febrile neutropenia (p.value <0.05).
from this study we concluded that:
Adrenomedallin is a new marker which increased in 5th day than 1st
day in febrile neutropenic episode in pediatric malignancy, and more
sensitive and specific than CRP.
Also CRP stills an effective cheap marker that should be used in
febrile neutropenic episode.