الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Patients with hematological malignancies are immune compromised as a result of the underlying malignancy or due to the therapeutic interventions employed to manage it.
Neutropenia is a frequent complication of chemotherapy and occurs when myelosuppressive chemotherapeutic treatment reduces absolute neutrophil counts. The condition predisposes cancer patients to potentially life threatening infection .Most, if not all, episodes of fever during neutropenia are supposed to be infectious in origin. Infection, however, is documented only in a minority of cases.
The diagnosis of blood stream infections could prove really challenging in onco-hematological patients, who routinely receive prophylactic antibiotics and whose blood cultures therefore often remain negative. Even after the detection of growth in cultured blood (usually not before 6–12 h of incubation), conventional blood cultures require at least a further 24– 48 h for the definitive identification of the pathogen and the evaluation of its sensitivity to antibiotics .A sepsis biomarker needs to be able to differentiate accurately and early bacterial infection from non infective causes of fever.
Procalcitonin has been identified as a valuable marker of bacterial sepsis and severe bacterial organ infections with superior diagnostic accuracy when compared to CRP and other inflammatory markers.
A patient with FN should be treated as a medical emergency, requiring immediate medical attention. Assessment by medical personnel should occur quickly .Immediate broad spectrum antibiotic
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treatment is mandatory in febrile neutropenic patients, but may frequently lead to overtreatment.
This study was conducted in an attempt to study the importance of procalcitonin in diagnosis of infection in febrile neutropenic patients with acute lymphoblastic leukemia .This study included 25 patients with ALL admitted to Hematology Oncology Unit of Menoufia University hospital. All 25 patients had ALL and suspected to have signs of bacteremia. Fever and neutropenia were the inclusion criteria in this study. All patients were subjected to taking a full medical history, complete general and systemic examination in addition to investigations collected from all candidates including; acomplete blood picture ,CRP,SGPT, Creatinine, serum sodium ,potassium ,blood culture and chest X-ray. Measuring Serum PCT on 1st and 5th days of fever using ELIZA.
The results obtained showed that the age of the patients ranged from 1 year to 14 years old and means age of 4.79 years. They were 15 males (60%) and 10 females (40%). Fourteen cases were from rural area (56%) and 11 cases were from urban area (44%). In this study we found all patients had pulmonary manifestation (cough and wheezing) and (56%) had pneumonia. Most of the patients (68%) had gram negative bacilli in blood culture results and (32%) gave fungal blood cultures mainly Aspergillus (62.5%).WBCs and neutrophils were significantly higher on 5th day than on 1st day of FN. And also shows that Hb and Platelets on 1st day were non significant correlated with its on 5th day of FN. There was no significant correlation between Procalcitonin and Na+ ,K+, Creatinine ,SGPT and CBC parameters on 1stday and on 5th day of FN and the same regarding CRP. There was a significant positive correlation between serum
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Procalcitonin level and blood culture and also shows that there was non significant correlation between procalcitonin level and days of neutropenia . Procalcitonin and CRP on 1st day were significantly higher than on 5th day of FN. The results of ROC analysis of procalcitonin and CRP showed that on 1st and 5th days of fever, the level of Procalcitonin could predict bacteraemia much better and more significantly than CRP,So PCT is a useful marker for diagnosis of infection in FN in ALL.