HR-001

cf. CA 63, 13843b.Since 2 immunologically specific hemorrhagic principles are present in the Habu venin, 2 distinct antibodies must be in the antivenin serums.The 2 venin fractions (HR-1 and HR-2) were separated by zone electrophoresis and used for the assay of the corresponding antivenins.HR-1 and HR-2 were similar in their hemorrhagic activity on rabbit skin.The ratio of anti-HR-1 and anti-HR-2 differed in different preparations of antivenin.Larger amounts of antivenin were required to neutralize HR-2 than HR-1.An antihemorrhagic unit is defined as the amount of specific antibody required to neutralize 100 min. hemorrhagic doses of venom when injected intracutaneously in the backs of rabbits.The hemorrhagic area was measured on the visceral side of the skin.The effective dose of antivenin is the quantity which when mixed with a given dose of toxin causes a hemorrhagic spot with an average diameter of 10 mm.This is determined by the statistical analysis of the dose-response curve.The anti-hemorrhagic activities of the antivenins were determined using both HR-1 and HR-2 fractions, and the antihemorrhagic activity expressed in terms of both fractions.

Children with acute lymphoblastic leukemia (ALL) are at a risk of developing influenza-related complications. Approximately 10% of influenza-infected children with ALL or other types of cancer need intensive care, and 5% of them eventually die.

We report 2 children with ALL and the swine-origin influenza A virus infection. Diagnosing influenza in them was a challenge. Medical records of these children were reviewed for demographic, clinical, and laboratory data. Patients were hospitalized in the Department of Pediatric Hematology, Oncology, and Transplantology of the Medical University of Lublin, Poland. Case 1 involved a 2-year-old girl who, according to acute lymphoblastic leukemia intercontinental Berlin-Frankfürt-Münster protocol 2009, started chemotherapy in July 2015. She was categorized in the intermediate risk group and received the induction and consolidation phase of the therapy without severe complications. The reinduction therapy was administered in the outpatient department till the 15th day. On the 20th day of this phase, she was admitted to our department with fever, mucositis, tachypnea, abdominal pain, and diarrhea. In September 2009, a 14-year-old boy (case 2) who, according to acute lymphoblastic leukemia intercontinental Berlin-Frankfürt-Münster protocol 2002, was categorized in the high-risk (HR) group, received the induction (Protocol I) phase of therapy without severe complications. On the 7th day of the HR-1 course, he manifested fever and strong, tiring cough, followed by strong mucositis. Chemotherapy had to be interrupted in both children.

Respiratory viral infections, causing pneumonia, occurred in both patients during anticancer treatment. Initially, the real-time polymerase chain reaction test for the swine-origin influenza A was negative in both patients, which delayed the diagnosis. Additionally, bacterial, and fungal complications were also observed.

Both patients received oseltamivir twice a day, a broad-spectrum antibiotic, antifungal drug, and granulocyte colony growth factor.

The disease progressed quickly, and our patients subsequently died.

We speculated that early antiviral treatment can help in the better management of patients in the HR group. It is also important to minimize influenza morbidity and mortality by vaccinating family members, using empiric therapy, providing immediate antiviral therapy, and educating parents about hygiene measures.