Patients and methods
The medical records available on BMTPlus5 of all 294 patients who underwent a total of 302 transplants at the Sankalp-People Tree Centre for Pediatric BMT, Bangalore (PTH) and Sankalp-CIMS Centre for Pediatric BMT, Ahmedabad (CIMS), between August 2015 and March 2020 were analysed to identify patients who had CVL removed while having a baseline platelet count less than 20,000/uL which identified 52 such instances. These 52 transplants had recipients were 31 boys and 21 girls with median age 10.1 (IQR 7.9-13.0) years. Indication for transplant was severe thalassemia for 46 patients, severe aplastic anemia for 4 patients, Fanconi’s anemia for 1 patient and sickle cell disease for 1 patient.
Blood counts, transfusions, maximum daily temperature, clinical notes, culture reports, C-reactive protein (CRP), Procalcitonin (PCT) and antibiotic therapy were extracted for these patients for the duration of 2 day prior to 2 day after CVL removal.
Patients who had a hemoglobin drop of more than 1 gm/dl on the day after line removal were identified. Defervescence (maximal daily temperature less than 380C) within 48 hours of line removal was the primary outcome sought. Antibiotics orders were reviewed looking for change on the same day as line removal. Any drop in CRP and PCT values post line removal was also examined for those who had CRP greater than 0.6 mg/dl and PCT greater than 0.5 ng/ml prior to line removal. Culture reports were examined to identify any evidence of central line infection. Clinical notes were reviewed to identify any complication related to central line removal.
CVL was removed at the bedside under local anaesthesia at PTH5 while sedation was employed at CIMS hospital6.
Fisher’s exact test was performed using R version 3.5.x to see if there was a difference between those who had a escalation/change in antibiotics versus those who did not at the time of line removal.