{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T10:33:11Z","timestamp":1787740391544,"version":"build-2784847793"},"reference-count":20,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2015,4,28]],"date-time":"2015-04-28T00:00:00Z","timestamp":1430179200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatrics International"],"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Among neonates with Down syndrome (<jats:styled-content style=\"fixed-case\">DS<\/jats:styled-content>) and transient leukemia (<jats:styled-content style=\"fixed-case\">TL<\/jats:styled-content>), hyperleukocytosis (white blood cell [<jats:styled-content style=\"fixed-case\">WBC<\/jats:styled-content>] count &gt;100 \u00d7 10<jats:sup>9<\/jats:sup>\/L) is associated with increased blood viscosity, respiratory failure due to pulmonary hypertension, multiorgan failure, and increased risk of early death. There have been no previous studies focusing on the effects of exchange transfusion (<jats:styled-content style=\"fixed-case\">ExT<\/jats:styled-content>) on <jats:styled-content style=\"fixed-case\">WBC<\/jats:styled-content> count, respiratory status, and other parameters in <jats:styled-content style=\"fixed-case\">TL<\/jats:styled-content> patients with hyperleukocytosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An observational retrospective study was carried out at a single center of all five <jats:styled-content style=\"fixed-case\">DS<\/jats:styled-content> neonates with <jats:styled-content style=\"fixed-case\">TL<\/jats:styled-content>, <jats:italic>GATA1<\/jats:italic> mutations, and hyperleukocytosis, born at a median gestational age of 34\u2009weeks (range, 30\u201338\u2009weeks) with birthweight 2556\u2009g (range, 1756\u20133268\u2009g) during a 24\u2009month study period between <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>eptember 2011 and <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>ugust 2013. All five neonates underwent <jats:styled-content style=\"fixed-case\">ExT<\/jats:styled-content> at a median age of 2\u2009days (range, 0\u20135\u2009days) before initiation of other cytoreductive therapy with cytarabine, which was carried out in two patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All patients required respiratory support before <jats:styled-content style=\"fixed-case\">ExT<\/jats:styled-content>. After <jats:styled-content style=\"fixed-case\">ExT<\/jats:styled-content>, respiration status improved in all five patients: <jats:styled-content style=\"fixed-case\">WBC<\/jats:styled-content> count (mean) decreased by 85% from 143 \u00d7 10<jats:sup>9<\/jats:sup>\/L to 21 \u00d7 10<jats:sup>9<\/jats:sup>\/L. None developed tumor lysis syndrome. Three survived and two died: one hydrops fetalis neonate born at gestational week 30 died at age 5\u2009days, and another died eventually from acute gastroenteritis 40\u2009days after leaving hospital at the age of 155\u2009days with complete remission. Two of the three surviving neonates developed acute megakaryocytic leukemia at age 90\u2009days and 222\u2009days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">ExT<\/jats:styled-content> was very effective in improving hyperleukocytosis and may have had favorable effects on respiration.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ped.12586","type":"journal-article","created":{"date-parts":[[2015,1,23]],"date-time":"2015-01-23T09:29:44Z","timestamp":1422005384000},"page":"620-625","source":"Crossref","is-referenced-by-count":13,"title":["Exchange transfusion in patients with Down syndrome and severe transient leukemia"],"prefix":"10.1111","volume":"57","author":[{"given":"Itaru","family":"Hayasaka","sequence":"first","affiliation":[{"name":"Maternity and Perinatal Care Center Hokkaido University Hospital  Sapporo 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