内科: オープンアクセス
オープンアクセス

概要

Hemophagocyticlymphohistiocytosis (HLH): A systematic review on approach to diagnosis and management of HLH as an emerging non-malignant disease with high morbidity and mortality in children and adults

Mahdi Shahriari

Hemophagocyticlymphohistiocytosis (HLH) is a rapidly progressive, life-threatening syndrome of excessive immune activation. Prompt initiation of treatment for HLH is essential for the survival of affected patients. Although haematologist oncologists will treat these patients, but general paediatricians, immunologists, gastroenterologists, infectious men and even internists and adult oncologists should be familiar with diagnosis of this disease which has high morbidity and mortality; and its treatment before progression of neurologic complications is helpful. Presentation of HLH will be mentioned to be considered in the differential diagnosis of critically ill patients with prolonged fever, splenomegaly, cytopenia, jaundice, coagulopathy, etc. Method: English language large data bases including PubMed Central (Medline), EMBASE, Science Direct, ISI, ISC and Google Scholar were reviewed using these keywords: HemophagocyticLymphohistiocytosis, Diagnosis and/or treatment of HLH, genetic predisposition to HLH, Children or Adults with HLH. Fifty seven review articles were enrolled. Results: OVERVIEW AND INDICATIONS FOR TREATMENT: Hemophagocytic lymphohistiocytosis (HLH) is a dynamic disorder of unchecked insusceptible initiation and tissue harm. In the event that left untreated, patients with HLH make due for just a couple of months, because of dynamic multi-organ disappointment. Regularly, the best boundary to treatment and a fruitful result for people with HLH is a deferral in finding. A few parts of the clinical presentation of HLH add to this postponement, including the uncommonness of the disorder, the variable clinical presentation, and the absence of specificity of the clinical and research facility discoveries. Diagnostic criteria for HLH include molecular testing consistent with HLH or 5 of 8 of the following criteria: fever, splenomegaly, cytopenias affecting ≥2 lineages, hyperferritinemia, hypertriglyceridemia and/ or hypofibrinogenemia, hemophagocytosis (in bone marrow, spleen, or lymph node), impaired NK cell function, and elevated soluble CD25 (sCD25) (ie, sIL2R). Additional discoveries that are regular are transaminases, coagulopathy, hypernatremia, edema, rash, hypoalbuminemia, hoisted lactate dehydrogenase (LDH), C-responsive protein, and d-dimer, expanded lowthickness lipoprotein, diminished high-thickness lipoprotein, lifted cerebrospinal liquid protein and cells, and neurologic indications running from central shortages to adjusted mental status. Any patient with suspected HLH ought to be seen by a haematologist, and the individuals who are intensely sick ought to be exchanged eminently to an office where they can get HLH treatment.Hemophagocytic lymphohistiocytosis (HLH), otherwise called haemophagocytic lymphohistiocytosis, and hemophagocytic or haemophagocytic syndrome, is an exceptional hematologic issue seen more regularly in kids than in grown-ups. It is a perilous sickness of extreme hyperinflammation brought about by uncontrolled multiplication of actuated lymphocytes and macrophages, portrayed by expansion of morphologically kindhearted lymphocytes and macrophages that discharge high measures of provocative cytokines. It is delegated one of the cytokine storm conditions. There are acquired and non-acquired (procured) reasons for hemophagocytic lymphohistiocytosis (HLH).The beginning of HLH happens younger than one year in roughly 70 percent of cases. Familial HLH ought to be suspected if kin are determined to have HLH or if side effects repeat when treatment has been halted. Each full kin of a youngster with familial HLH has a twenty-five–percent possibility of building up the sickness, a 50% possibility of conveying the deficient quality (which is once in a while connected with any danger of malady), and a twenty-five–percent possibility of not being influenced and not conveying the quality imperfection. Patients with HLH, particularly when untreated, may require escalated treatment. In this manner, HLH ought to be remembered for the differential conclusion of emergency unit with cytopenia and hyperferritinemia. Patients in the previous phases of HLH are much of the time hospitalized at interior medication wards. HLH clinically shows with fever, augmentation of the liver and spleen, broadened lymph hubs, yellow staining of the skin and eyes, and a rash. Research center discoveries may incorporate raised triglyceride levels, low fibrinogen levels, transaminitis, and raised ferritin levels (among others). Essential HLH is brought about by loss of capacity, (for example inactivating) changes in qualities that code for proteins cytotoxic T cells and NK cells use to murder focused on cells, for example, those contaminated with microbes like the Epstein-Barr infection (EBV) or the Dengue virus. These transformations incorporate those in the accompanying qualities: UNC13D, STX11, RAB27A, STXBP2, LYST, PRF1 1, SH2D1A, BIRC4, ITK, CD27, and MAGT1. Auxiliary HLH (sHLH) is related with, and thought to be advanced, by threatening and non-harmful illnesses that in like manner debilitate the capacity of the safe framework capacity to assault EBV-tainted cells. Harmful issues related with optional HLH incorporate T-cell lymphoma, B-cell lymphoma, intense lymphocytic leukemia, intense myeloid leukemia, and myelodysplastic disorder. Non-harmful issues related with auxiliary HLH include: immune system issues, for example, adolescent idiopathic joint pain, adolescent Kawasaki ailment, fundamental lupus erythematosus, the adolescent beginning and grown-up beginning types of Still’s ailment, and rheumatoid arthritis; immunodeficiency issues, for example, extreme consolidated immunodeficiency, DiGeorge disorder, Wiskott–Aldrich condition, ataxia–telangiectasia, and dyskeratosis congenita); and contaminations brought about by EBV, cytomegalovirus, HIV/AIDS, microbes, protozoa, growths and potentially SARSCoV- 2. Secondary HLH may likewise result from iatrogenic causes, for example, bone marrow or other organ transplantations; chemotherapy; or treatment with immunosuppressing specialists About 33% of all HLH cases, ~75% of Asian HLH cases, and almost 100% of HLH cases brought about by transformations in SH2D1A (see X-connected lymphoproliferative ailment type 1) are related with, and thought activated or advanced by, EBV disease. These instances of HLH are delegated having a place with the class of Epstein–Barr infection related lymphoproliferative maladies and named EBV+ HLH.