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We present a case of an arterio-venous fistula that developed in the early postoperative course after wedge resection of the right upper lobe. A 57-year old male treated for acute myeloid leukemia was referred from the hematology department because of a right upper lobe tumor. Wedge resection was performed. Three weeks later recurrent tumor was visualized on chest X-ray. Angio-CT diagnosed an arterio-venous fistula and the patient was scheduled for redo surgery. Completion upper lobectomy was performed and the pathological examination confirmed iatrogenic arterio-venous fistula. To our knowledge such an early complication has never been reported so far. Iatrogenic intrapulmonary arterio-venous fistulas are very rare. We present a case of such fistula that developed early after wedge resection of the right lung upper lobe tumor and presented as recurrent pulmonary mass. To the best of our knowledge this is the first description of such a case.

Yan-hui Wei,1 Yu-zhuo He,2 Xiao-yan Guo,1 Xiao-yan Lin,2 Hong-bin Zhu,2 Xue-jun Guo2 1Department of Graduate School, Xinxiang Medical University, Xinxiang, Henan Province, 453003, People’s Republic of China; 2Department of Hematology, Puyang Oilfield General Hospital, Puyang, Henan Province, 457000, People’s Republic of ChinaCorrespondence: Xue-jun GuoDepartment of Hematology, Puyang Oilfield General Hospital, Puyang, Henan Province, 457000, People’s Republic of ChinaTel/Fax +86-13903930612Email pygxj@163.comObjective: This study aimed to determine the incidence of iron-deficiency anemia (IDA) complicated by splenomegaly in our hospital over the past 6 years and to analyze the possible causes of this result.Methods: This is a retrospective study. In total, 668 patients with IDA who were hospitalized in the hematology department of our hospital from 2013 to 2019 were selected as the research subjects and included in the IDA group, and 3201 patients who underwent outpatient physical examinations in our hospital during the same period were included in the control group. The incidences of splenomegaly in the IDA and control groups were calculated, and the difference was analyzed by means of statistical methods.Results: Among the 668 IDA patients, 46 (6.9%) had splenomegaly, and among the 3201 patients in the control group, 21 had splenomegaly (0.7%). The incidence of splenomegaly was significantly higher in the IDA group than in the control group, and the severity of anemia in the IDA group was associated with the occurrence of splenomegaly. Specifically, the incidence of splenomegaly was 12.4% among patients with severe anemia and as high as 50% among patients with extremely severe anemia.Conclusion: IDA is correlated with the incidence of splenomegaly, and the incidence of splenomegaly significantly increases as the severity of IDA increases. This is considered to be caused by extramedullary hematopoiesis.Keywords: iron-deficiency anemia, splenomegaly, extramedullary hematopoiesis, cytokines

Aim. To determine the opinions of II and III stage breast cancer patients on the non-pharmacological pain-relief methods. Methods. The research was performed from November 2019 to January 2020 in the Oncology and Hematology department of Lithuanian University of Health Sciences Kaunas Clinics. Patients completed a survey of 25 questions. 33 surveys were analysed. Statistical data analysis was performed using IBM SPSS Statistics 25.0 and Microsoft Excel 2016 software packages. Results. Almost half of the survey participants were unaware of the pain-relief methods, had not tried any of physical pain-relief methods and did not know or have an opinion about their effectiveness. Half of the survey participants thought that music, spiritual and cognitive behavioral therapies can relieve the pain. Also, more than half of the participants had not tried any psychological pain-relief methods and did not know or have an opinion about their effectiveness. More than half of the participants did not know if it is possible to reduce pain using medical marijuana, virtual reality glasses and hypnosis.

The hematology care, research, and development in West Bengal had a glorious past. Dr. J.B. Chatterjea represented the pioneers in hematology practice and research from Calcutta, West Bengal. Calcutta School of Tropical Medicine (CSTM) is considered as the birthplace of Hematology not only in India but also in whole of Asia. Dr. J.B. Chatterjea single handedly took the Hematology Department to a new height and made it a center for learning and advanced research in hematology. Subsequently, many of his able disciples spread out elsewhere in the country expanding the mission of research in hematology. The tragic untimely death of Dr. Chatterjea in 1972 was an irreparable loss to the development of hematology in this country. The glory and glamor of hematology care and research in West Bengal faded way over time. In the recent years, with the establishment of new hematology care and research units at other Government Medical Colleges, private sectors and enormous contributions from the basic scientists have helped to rescue the lost glory and shaping the present day comprehensive hematology care and research in West Bengal, India. In this brief review, the present author tries to give an overview of the past and present of hematology care and research in West Bengal and the author in the present review does not claim to have described every bit of hematology development in this part of the country.

Background. The annual reporting forms for malignant neoplasms do not provide for the division of lymphomas into variants. In international publications and statistical reference books of the Russian Federation, variants of non-Hodgkin’s lymphomas (NHL) are also not separated. For these reasons, a detailed assessment of the epidemiology of NHL in Russia is difficult, and data for individual variants of the disease are not provided.Purpose: to present the clinical and epidemiological characteristics of Diffuse Large B-cell Lymphoma (DL BCL ) in Novosibirsk according to the data of the City Hematology Center (CHC).Material and Methods. A retrospective analysis of primary medical documentation (case histories, outpatient charts, and immunohistochemical study reports) of 271 patients with DL BCL was performed in the period from January 1, 2013 to December 31, 2018.Results. The calculated registered primary morbidity and mortality from DL BCL in Novosibirsk for the analyzed years fluctuated slightly. The average incidence and mortality rates were 2.85 and 1.98 per 100,000 population, respectively. When analyzing the dynamics of the prevalence of DL BCL in Novosibirsk, a positive trend of annual increase in the indicator was revealed: 1.87 times over the past 6 years. In men, the tumor developed 2.6 years earlier than in women. In General, the risk of getting DL BCL after 50 years was 3 times higher than at the age of 30 years. Among patients diagnosed with primary lymphoma who underwent treatment at the Hematology department of CHC, half of the patients had DL BCL .Evaluation of the clinical characteristics showed a pronounced severity of the analyzed cohort.Conclusion. The updated quantitative and qualitative indicators of clinical and epidemiological characteristics of DL BCL in Novosibirsk for 2013–18 were obtained. These indicators can be used for further monitoring, development and implementation of measures for the prevention, diagnosis and treatment of this form of hemoblastosis.

Von Willebrand’s disease was first described in 1926 by Erik Von Willebrand. It is a genetic, constitutional defect of hemostasis that is different from hemophilia. It is classified among the rare diseases whose clinical manifestations are dominated by a hemorrhagic profile, which varies from patient to patient. It is an easily diagnosed disease based on a quantitative and qualitative bioassay of VWF. Treatment is multidisciplinary and is based on well-structured prevention. We report the first case of von Willebrand disease in Niger, diagnosed in the Hematology Department of Niamey’s National Hospital.

Metagenomic Next-Generation Sequencing (mNGS) is an emerging technique for microbial identification and diagnosis of infectious diseases. The clinical utility of mNGS in the management of infections, especially its real-world impact on antimicrobial therapy and patient outcome has not been systematically evaluated. To that end, we prospectively assessed the effectiveness of mNGS in 70 febrile inpatients with suspected infections at the Hematology department of the Childrens Hospital, National Clinical Research Center for Child Health. 69/70 patients were given empirical antibiotics prior to mNGS. A total of 104 samples (62 plasma, 34 throat swabs, 4 bone marrow, 4 bronchoalveolar lavage) were collected on day 1-28 (mean 6.9) after symptom onset and underwent mNGS testing. Traditional microbial tests such as culture identified causal microorganisms in 5/70 (7.14%) patients that were in accordance with mNGS. In addition, mNGS reported possible pathogens when routine tests were negative. Antimicrobial treatment was adjusted in 55/70 (78.6%) patients that led to improvement/relief of symptoms within 3 days. On the other hand, in 15/70 (21.4%) patients, mNGS reports were considered irrelevant by a board of clinicians based on biochemical, serological, imaging evidence and experiences. We concluded that mNGS not only expanded the clinical capacity of pathogen detection, but also yielded positive impact on handling suspected infections through 1) differential diagnosis which may rule out infectious diseases and 2) modification and de-escalation of the empirical antibiotic regimen.

Introduction Acute leukaemia are the clonal and malignant proliferation of immature hematopoietic cells (blast), blocked in their differentiation process. There is an interaction between cancer cells and the clotting process. This could be the expression of Tissue Factor (TF) on the surface of tumor cells; or a lesion of the vascular endothelium and platelet activation. The result is an activation of clotting that can lead to disseminated Intravascular Coagulation (DIC). The objective of this study was to assess the risk of DIC occurring in patients with acute leukaemia. Methods This was a cross-sectional study for analytical purposes that took place on 40 frozen samples from the biobank of the haematology laboratory of Teaching Hospital Yopougon for which the diagnosis of acute leukaemia had been taken from myelogram. The myelogram results were accompanied by hemogram data. PTTa, QT, fibrinogen and D-Dimers were performed on these samples. The risk assessment of DIC occurred was determined on the recommendations of the International Society of Thrombosis and Hemostasis (ISTH). Results We noted a female predominance with a Sex Ratio (M / F) of 0.90. The average age of the patients was 38 years (± 23 years) with extremes ranging from 2 to 84 years. ALL represented 20 % of cases against 80 % for AMLs. Hemogram parameters were characterized by severe anaemia (Tx Hb < 6 g / dL) in 52.5 % of cases; hyperleukocytosis > 100.103 / mm3 in 35 % of cases; thrombocytopenia < 25.103 / mm3 in 40 % of case; and significant blood and spinal cord blastosis (> 80 %). The lengthening of the PTTa was observed in 50 % of cases, compared to 40% for the QT. Similarly, hyperfibrinemia was present in 65% of cases. D-Dimers were high in almost all subject (95 % of cases). According to the ISTH criteria, 17.5 % of subjects were at risk of developing a DIC. Conclusion The risk of occurrence of DIC is indeed present during acute leukaemia. The parameters of haemostasis are thus found to be crucial data in the follow-up assessment during the diagnosis of acute leukaemia.

Background: Patients presenting with acute myeloid leukemia (AML) at diagnosis are at high risk of severe complications and death, particularly with high white blood cell (WBC) count. In this retrospective study, we evaluate interest of early and systematic support in the intensive care unit (ICU) for AML with hyperleukocytosis (AML-HL) at diagnosis. Methods: Patients with AML-HL, defined by WBC > 50 × 10 9 /L, primary referred in ICU (“Early ICU”) without organ failure and before initiating chemotherapy induction were compared to patients first admitted in the Hematology Department who required a secondary transfer in ICU ( “Late ICU” ) or not ( “No ICU” ). Primary end point was mortality during the first month, and secondary end points were the use of life-sustaining therapies in ICU and risk factors for ICU transfer and mortality. Results: One hundred fifty-four patients were included: 77 (50%) to the group “No ICU” , 18 (12%) to “Late ICU” and 59 (38%) to “Early ICU” . Mortality at day 30 was higher in “Late ICU” than in "Early ICU" and "No ICU", with 27.8%; 16.9% and 2.6% respectively (P < 0.001). "Late ICU" patients had an increased use of life-sustaining therapy comparing to "Early ICU" patients (56% vs. 29%, P = 0.04). Conclusions: Early referral to ICU reduces morbidity and seems an effective strategy to reduce short-term mortality in AML-HL at diagnosis. J Hematol. 2020;9(4):109-115 doi: https://doi.org/10.14740/jh691

Policy development on chemotherapy management has increased the demand for deeper knowledge in this field. In this way, there was a need to identify, recognize the consumption trends of chemotherapeutic and prioritize the interest of regulatory bodies, as well as to design programs for health education. In 1978 for the first time in Kosovo, a Hematology Department was established within the Internal Diseases Clinic by Dr. Shaban Geci. In 2013 it became a Clinic of Hematology. The Department of Clinical Hematology deals with the diagnosis of hematologic and hematopoietic diseases including erythrocytes, leukocytes, platelets as well as malignant diseases. Within the department is also the location for puncture and biopsy of the bone marrow as well as for ultrasonography. Methods: The study was prospective and was conducted at University Clinical Center of Kosova (UCCK) and is based on an anonymous survey designed specifically for this purpose. The subject of the analysis was the available space for hospitalization and administration of chemotherapeutic at UCCK, the existence or not of written protocols, and available technical equipment. Results: Respondents were asked how many nurses handle the administration of cytostatic at the clinic where they work. 48% of respondents state that 1 - 5 nurses deal with cytostatic administration, 52% of respondents say 1 - 15 nurses deal with cytostatic administration, while alternatives 6 - 10 nurses and 16 and more nurses were not selected by no respondents.

Genotypic diagnosis of HSV drug resistance can be performed routinely in a clinically relevant time. Nevertheless, data about HSV mutations (polymorphism or resistance) is not exhaustive which hinders the interpretation of such tests. The UL23, UL30, and UL5 genes are of greatest interest as these encode, respectively, thymidine kinase, DNA polymerase, and helicase, which, if mutated may affect the effectiveness of acyclovir, foscarnet, cidofovir, and helicase-primase inhibitors. The present study aimed to extensively characterize UL23, UL30, and UL5 genes. A total of 239 clinical HSV1 recovered from patients admitted to the hematology departments of the Lyon teaching hospitals were included in this single-center retrospective study. Drug resistance was evaluated using the neutral red dye-uptake assay, and sequencing using the Sanger method. Additional information on HSV1 natural polymorphism and resistance is now available. Twenty-two amino acid substitutions related to polymorphism were described on UL23 (E43A, L50M, L68R, Q109K, A133V, A136N, S150L, D258N, S263L, P280S, N301S, A316S, M322L, I326V, D330A, D338H, Q342H, T344I, Q349R, V352L, R370W, E371D), and 6 amino acid substitutions on UL30 (G641R, G645D, E649G, G679D, R681L, I966M). Moreover, the UL23 substitution L242P was added to ACV resistance-related mutations. There were 12 substitutions on UL23 (A37S, V70M, S74L, H151N, P154S, P155Q, L159R, E225L, Y248H, Q270R, N303Y, M372I), and 8 on UL5 (L49I, L138V, S173L, A280T, A575V, V600A, A602T, D862N) that remain of unclear significance with regards to drug resistance. The mean (±standard deviation, SD) number of natural polymorphisms in UL23 was 2.53 (±2.55), in UL30 it was 0.83 (±1.02), and in UL5 it was 5.00 (±1.59) There was no association between HSV1 phenotype and the frequency of substitutions. The results reported herein provide valuable new information concerning HSV1 mutations that will assist the interpretation of genotypic assays.

Se presenta el caso de un paciente masculino de 2 años portador de una leucemia linfoblástca aguda con neutropenia severa, quien mientras se encontraba en el día 22 de la fase de consolidación para el tratamiento de su leucemia, presentó un shock séptico asociado a una bronconeumonía por Pneumocystis jirovecii. El paciente ameritó terapia con membrana de oxigenación extracorpórea (por sus siglas en inglés, ECMO) como parte de su manejo y, una vez controlada la fase de shock séptico, se logró decanular al quinto día sin complicaciones para continuar su tratamiento en el servicio de hematología.

Background: Cancer is among the leading causes of mortality in India. Studies have reported antineoplastic agents as the common class of drugs causing Adverse Drug Reactions (ADRs). The present study aimed to conduct active surveillance of ADRs of anticancer drugs in the hematology department. Methods: A prospective observational study was conducted in 136 patients with cancer and the incidence and frequency of ADRs were assessed. The study was conducted in 6 months in a multispecialty hospital. Results: Among 136 cancer patients, All was more prevalent (39.70%); CLL, Non- Hodgkin’s Lymphoma were less prevalent (0.73%). ADRs were more prevalent in the Pediatrics department, i.e., 18.53% of ADRs were observed in patients aged

Introduction. Leukemia is a broad term that refers to a group of malignant diseases of the bone marrow and lymphatic system. Caregiver burden is one of the issues that are faced by primary caregivers, and this role is played by mothers in most cases. In addition to these problems, mothers experience frustration in performing tasks, isolation and failure due to inadequate education about the disease and inadequate information support. The aim of the present study was to determine the effect of education on the caregiver burden (CB) among mothers of children with leukemia. Material and methods. The present quasi-experimental study was performed on mothers of children with leukemia in the Hematology Ward of Ali ibn Abi Talib Hospital of Zahedan in 2019. Convenience sampling was used to select eligible mothers. At the baseline, the control group was selected according to the inclusion criteria (this method was to prevent the effect of the intervention on the control group). Then, a questionnaire including demographic information, and caregiver burden inventory (CBI) were completed in two stages: pre-test and post-test. To this end, after completing the questionnaire, the first training session was held in the hematology department individually for 30 to 45 minutes with a specific content. Also, after completing three training sessions, phone follow-up was performed weekly for 4 weeks to ensure that the intervention was implemented. The questionnaires were redistributed and recompleted by intervention and control groups again four weeks after the intervention. Results. The mean pre-intervention CB score in the intervention and control groups was 19.97 ± 5.25 and 18.97 ± 10.03, respectively. The mean post-intervention CB score was also 17.17 ± 4.78 and 19.18 ± 9.93, respectively. Intervention significantly reduced CB score in the intervention group (p < 0.001). Conclusions. The findings showed that training was effective in reducing the CB score among mothers of children with leukemia. Therefore, it is recommended to use training as a non-pharmacological and appropriate method in reducing CB among mothers of children with leukemia.

Purpose Protontherapy for mediastinal Hodgkin lymphoma reduces cardiac, lung and breast exposure, which may limit radiation-induced adverse events. While this technique is already widely implemented in the United-States, clinical experience is still limited in France. This study analyses the practice of mediastinal Hodgkin lymphoma protontherapy at the Institut Curie to implement this technique at a larger scale. Materials and Methods Data from all mediastinal Hodgkin lymphoma patients from the hematology department of the Institut Curie who were subsequently evaluated at the Protontherapy Center of Orsay (CPO) of Institut Curie for adjuvant protontherapy were retrieved. We analyzed why these patients were ultimately treated with protontherapy or not. Results Between January 2018 and January 2021, twenty mediastinal Hodgkin lymphoma patients from the hematology department of the Institut Curie have been screened for protontherapy at the CPO. Four of them (20%) were ultimately treated with proton beams. Treatment was well tolerated without grade 3–4 adverse events. With a median follow-up of two years, none of these patients relapsed. The others sixteen patients were not treated with protontherapy due to multiple reasons including: lack of treatment room disponibility, accessibility difficulties, psychiatric disorder, and anatomic or dosimetric considerations. Conclusion Despite notable dosimetric superiority over photon radiotherapy and excellent clinical tolerance, lack of availability of protontherapy facilities limit implementation of mediastinal Hodgkin lymphoma protontherapy. Additionally, strict selection criteria must be defined.

Objective: Description of the situation of handling chemotherapy at home for caregivers of pediatric patients with acute leukemia from June 01st to July 31st, 2020. Method: case series description. Results: Eighty-seven caregivers were surveyed. 100% caregivers received instruction on safe handling of oral chemotherapy at home from physicians, 25.3% caregivers received instruction from nurses, 83.9% patients whose mother prepared medication and 14.5% are pregnant. To prepare medication, 47.1% caregivers used the family room and 46% used bed room. 75.9% children who have to divide medication into smaller, 23.6% of children have to dissolve after crushed, 86.8% person who used table crushers, 80.4% of caregivers do not use any means of personal safeguards when handling chemotherapy, 82.4 % disposed it in regular garbage after used, 59.8% of caregivers always wash their hands after handled chemotherapy, 77% caregivers saved medication for using later when needed and 6.9% put left medication to normal garbage. Conclusion: Although 100% of caregivers received instruction on safe handling but in terms of practice, according to APHON, it is not enough and some practices are not safe for caregivers and community. Counselling should be improved to be sure safety for caregivers, pediatric patients and community.

The Aim: The aim of this study was to evaluate the effectiveness of a training module about safety bloodtransfusion on nurses’ competence. Methods: Pre experimental one group pre and post-test design wasadopted. The study was conducted at the hematology department in Oncology Center Mansoura UniversityHospital. A convenient sample of 60 staff nurses were included. Data were collected by a structured interviewquestionnaire to assess nurses’ knowledge level and observation checklist to assess nurses’ practices pre,and post-blood transfusion training. Data were analyzed by using both descriptive and inferential statistics.Results: Revealed a highly statistically significant difference in the mean score of the nurses’ knowledgelevel and practice about safe blood transfusion pre and post the training intervention (p=0.001). There wasa strong positive relation between nurses’ knowledge and practices scores post-training (r=0.745, P

Prolonged tourniquet stasis induced by venepuncture can lead to the release of the plasma of cell lysis products, as well as tissue factor (TF), impairing the quality of coagulation test results. The accidental presence of TF in vitro can trigger the coagulation mechanism, generating a false decrease in prothrombin time (PT). Background and Objectives: Identification of short PT tests below the normal reference value that could suggest a situation of hypercoagulability. The study aimed to compare the results of the shortened PT tests at their first determination with the eventual correction following duplication of the analysis from the same sample. Materials and methods: Identification of the shortened PT tests has been carried out for a period of 4 months, upon 544 coagulation samples referred to the Hematology department of Sf. Spiridon County Clinical Emergency Hospital from Iasi, Romania. Results: Out of the 544 samples of which the results indicated a state of hypercoagulability, by repeating the determination from the same sample, for 200 (36.76%) PT tests (p = 0.001) the value was corrected, falling within the normal reference range. For 344 (63.24%) tests, the results suggested a situation of hypercoagulability. Conclusions: In order to guarantee the highest quality of the laboratory services, a proper interpretation and report of the patients&rsquo, results must be congruent and harmoniously associated to the actual clinical condition of the patient. Duplication of the PT determination from the same sample would exclude situations of false hypercoagulability and would provide significant improvement for the patient&rsquo, s safety.

Objective: To determine the correlation between automated and the Westergren method for determination of ESR in symptomatic patients. Study Design and Setting: This cross sectional study conducted at Hematology Department of PNS Shifa Hospital Karachi. Methodology: Sample size was determined by using WHO sample size calculator. Westergren method was performed according to ICSH’s specifications. ESR vacuum tubes containing sodium citrate were used. The sedimentation of the RBC’s was recorded visually after 1 hour using a timer. Automated ESR was performed by TEST1 automated ESR analyzer (ALIFAX SpA, Italy). It uses K3-EDTA or K2-EDTA as an anticoagulant. Bias was controlled by inclusion and exclusion criteria and the confounding factors like temperature of lab and effect of wind were controlled by taking appropriate measures. Pre-designed proforma was used to collect the data that was analyzed through SPSS version 16. Correlation between the two methods was measure through Pearson correlation coefficient analysis. Results:. The ESR measured by Westergren method ranged from 2 mm/1st hour. to 131 mm/1st hour, with a mean of 39.94±29.60 mm/1st hour. while ESR measured by automated method ranged from 2 mm/1st hour. to 120 mm/1st hr. with a mean of 41.67±32.43 mm/1st hour. There was significantly strong correlation between automated and the Westergren method for determination of ESR (r =0.945; p =

The aim of this study is to investigate the effective therapeutic combination of recombinant VIIa(Novoseven) and factor eight inhibitor bypass activity(FEIBA) drugs for the bleedings of adult hemophiliac patients with inhibitors.19 bleeding episodes of 5 hemophilia A patients who were using bypassing agents and followed-up between 2008 and 2016 in Hacettepe Hematology Department were analyzed retrospectively. In 11, 5 and 3 bleeding episodes, FEIBA, recombinant factor VIIa and FEIBA+recombinant factor VIIa were given to the patients, respectively. The treatment durations differed between 1 and 14 days depending on the bleeding and clinical course of the patients. Generally the treatment with bypassing agents was successful, and only in one patient who had elbow hematoma encountered serious bleeding which was taken under control by switching the bypass agent. We offer a different approach because of three reasons. Firstly, in our protocol we start the treatment with recombinant factor VIIa for the first three days. Secondly, our protocol is adjusted to consider health economics. Thirdly, we extended the time interval between doses of both bypassing agents without increasing bleeding risks because the half-life of both agents enables us to modify the protocol with more flexibility. To conclude, we have evaluated our clinic’s data about hemophilia A patients with inhibitors and we offer a different protocol in the management of bleeding episodes for these patients.

In 2017 the organization of the children’s hematology service celebrated the 50th jubilee in St. Petersburg. The first specialized children’s hematology department in Leningrad (now St. Petersburg) was opened in 1967. Over the years, a strong network of institutions that allowed to provide highly qualified assistance to all children in need with hematological diseases has been formed in the city with the population greater than 5 million: the number of divisions reached seven and its curative capacity is more than 180 beds. The article describes the main phase of the development of the hematological service in St. Petersburg.

The aim of this study was to evaluate the implementation of human immunodeficiency virus (HIV) screening with rapid tests in an oncologic center in Mexico City, report the HIV prevalence, and describe contacts screening and linkage to HIV care while identifying barriers to the performance of the program. In 2014, an HIV rapid test program was implemented in four departments of the hospital “Instituto Nacional de Cancerología”. From 2014 to 2016, 3032 HIV rapid tests were performed in the hospital. The overall HIV prevalence was 0.8%, with the highest prevalence in the Hematology Department (2.4%). In the Gynecology Department, prevalence was 0.05%. Only 25 and 22 tests were performed in the lung cancer and germ cell tumor clinic, respectively, with one positive test. The health staff not offering the test was the main limitation to the full implementation of the program in those departments. The contacts screening led to three positive cases. The acceptance of the test was 99%. Patients who tested positive were seen by an infectious diseases physician on the same day the test was performed. Rapid HIV tests are a useful tool to expand HIV diagnosis in patients with cancer and to establish a rapid linkage to HIV care. Staff education needs to be improved to raise awareness of the health staff for a successful scale up of the program.

The management of acute myeloid leukemia (AML) gradually turns into an individualized approach with the application of targeted therapies. Venetoclax is a BCL-2 inhibitor that is synergistic with azacitidine. In this case series, 14 patients diagnosed with relapsed / refractory AML and 1 MDS RAEB-1 were followed up with venetoclax + azacitidine in the Hematology Department Bursa Uludag University Faculty of Medicine were evaluated. The best responses obtained with venetoclax + azacitidine were complete remission (CR) in one patient, complete remission with incomplete hematologic recovery (CRi) in one patient, morphological leukemia-free state (MLFS) in 4 patients, and partial response (PR) in one patient. The median time to first response with treatment was one month (0.5-5). The time to enter early remission is critical. For this reason, deaths due to infection should be prevented. Although the toxicities of this combination therapy can be managed, close follow-up of the patients is mandatory. In conclusion, this combination therapy is promising as it is relatively well-tolerated, improves the quality of life, and prolongs survival.

This is a prospective study realized at the level of the hematology department and blood transfusion center of the University Hospital Center (CHU) of Dr Ben Badis of Constantine and spread out over a period of one year (from January 1st to December 31st). The work focused on the analytical processes mastery of the NFS needs a compulsory step concerning technical and organizational laboratory skills respecting the ISO 15189 laws going through a mastery of support processes (humain resourses, informatics, materials, documents, management) indispensable for the good function of analytic proceedings, a performance evaluation of the hematology analyzer Advia (2120 I and II and 560) and quality control management (intern, extern). The analytic performance evaluation of Advia gives reliable results reproductible and stable for use of the routine automatisation good inter-machine correlation and laboratory performance in terms of the quality extern evaluation with military hospital laboratory.

Aim/Background: Malignant diseases impair not only the quality of life of the patient but also the caregivers. The present study aims to investigate the quality of life in caregivers of the patients with hematologic neoplasms and determine the relationship between the subscales of quality of life (QOL) and socio-demographic characteristics of caregivers. Methods: One hundred consecutive caregivers of the patients who were hospitalized at Bone Marrow Transplant Unit and Hematology Department between 01 May 2015 and 30 June 2015 were included in this prospective, single center, cross-sectional study. Socio-demographic data of the patients and the caregivers were collected using a questionnaire form, QOL was evaluated using short-form 36. Results: Quality of life was found to be impaired in 46% of the caregivers. Given that a score of 100 defines full health status, bodily pain (31.3) and mental role (35.9) subscale scores were found to be the most affected subscales and physical functioning (71.8) subscale was found to be the least affected. There was a statistically significant difference between the age of the caregiver and physical role. Physical role and social functioning were better in caregivers who have economic support. There was a difference between employed and unemployed caregivers with regard to physical role and pain subscales. Overall health perception subscale score was higher for the caregivers of male patients. Graduates of the university were found to experience less pain. Conclusions: Cancer impairs not only the life quality of the patient but also the caregiver. So, the patient and the caregiver should be evaluated together and family physicians should take place in the center of and coordinate the interventions required for improving the quality of life of the caregivers.Giriş ve Amaç: Malign hastalıklar sadece hastanın değil, ailenin de yaşam kalitesini etkiler. Bu çalışmada hematolojik neoplazmı olan hastaların bakım verenlerinin yaşam kalitesinin araştırılması ve yaşam kalitesi alt ölçekleri ile bakım verenlerin sosyo-demografik özellikleri arasındaki ilişkinin belirlenmesi amaçlanmıştır. Yöntem: Bu prospektif, tek merkez, kesitsel çalışmaya 01 Mayıs 2015 ile 30 Haziran 2015 tarihleri arasında Başkent Üniversitesi Kemik İliği Nakli Ünitesi ve Hematoloji Bölümü’nde yatırılan yüz ardışık hastanın bakım verenleri alınmıştır. Hastaların ve bakım verenlerin sosyo-demografik verileri anket formu kullanılarak toplanmıştır, yaşam kalitesi ise kısa-form 36 ile toplanmıştır. Bulgular: Bakım verenlerin %46’sında yaşam kalitesinin bozulduğu bulunmuştur. Tam sağlık durumunu belirten skorun 100 olduğu düşünüldüğünde, vücut ağrısı (31.3) ve mental rol (35.9) en fazla etkilenen alt ölçekler iken fiziksel işlevselliğin (71.8) en az etkilendiği bulunmuştur. Bakım verenin yaşı ile fiziksel rol arasında istatistiksel olarak anlamlı fark vardı. Ekonomik desteği olan bakım verenlerin fiziksel rol ve sosyal işlev alt ölçekleri daha iyiydi. Çalışan ve çalışmayan bakım verenler arasında fiziksel rol ve ağrı alt ölçekleri bakımından fark vardı. Genel sağlık algısı alt ölçeği skoru erkek hastaların bakım verenlerinde daha yüksekti. Üniversite mezunlarının daha az ağrı yaşadıkları bulunmuştur. Sonuç: Kanser sadece hastanın değil, aynı zamanda bakım vericinin de yaşam kalitesini etkiler. Bu nedenle hasta ve bakım vericisi birlikte değerlendirilmeli, aile hekimleri bakım vericilerin yaşam kalitesinin artırılması için gereken girişimlerde merkezde olarak koordinasyon sağlamalıdır.

Background Advances in automated cell separators have improved the efficiency of plateletpheresis and the possibility of obtaining double products (DP). We assessed cell processor accuracy of predicted platelet (PLT) yields with the goal of a better prediction of DP collections. Study design and methods This retrospective proof-of-concept study included 302 plateletpheresis procedures performed on a Trima Accel v6.0 at the apheresis unit of a hematology department. Donor variables, software predicted yield and actual PLT yield were statistically evaluated. Software prediction was optimized by linear regression analysis and its optimal cut-off to obtain a DP assessed by receiver operating characteristic curve (ROC) modeling. Results Three hundred and two plateletpheresis procedures were performed; in 271 (89.7%) occasions, donors were men and in 31 (10.3%) women. Pre-donation PLT count had the best direct correlation with actual PLT yield (r = 0.486. P

// Dominik Dytfeld 1, 9, * , Magdalena Luczak 2, 11, * , Tomasz Wrobel 3, 9, Lidia Usnarska-Zubkiewicz 3 , Katarzyna Brzezniakiewicz 3, 9 , Krzysztof Jamroziak 5, 9 , Krzysztof Giannopoulos 6, 9 , Anna Przybylowicz-Chalecka 1 , Blazej Ratajczak 1 , Joanna Czerwinska-Rybak 1 , Adam Nowicki 1, 9 , Monika Joks 1, 9 , Elzbieta Czechowska 7, 9 , Magdalena Zawartko 8 , Tomasz Szczepaniak 1, 9 , Norbert Grzasko 6, 9 , Marta Morawska 6, 9 , Maciej Bochenek 1 , Tadeusz Kubicki 1 , Michalina Morawska 4, 9 , Katarzyna Tusznio 5 , Andrzej Jakubowiak 10 , Mieczyslaw Komarnicki 1 1 Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland 2 nstitute of Bioorganic Chemistry, Polish Academy of Sciences, Poznan, Poland 3 Department of Hematology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland 4 Department of Hematology, Hospital in Gorzow Wlkp, Gorzow Wlkp, Poland 5 Institute of Hematology and Transfusiology, Warsaw, Poland 6 Experimental Hematooncology Department, Medical University of Lublin and Hematology Department, St John's Cancer Center in Lublin, Lublin, Poland 7 Department of Internal Medicine and Hematology, Stanislaw Staszic Specialist Hospital, Pila, Poland 8 Department of Hematology, 109 Military Hospital, Szczecin, Poland 9 Researchers of Polish Myeloma Consortium 10 University of Chicago, Chicago, IL, USA 11 Institute of Chemical Technology and Engineering, Poznan University of Technology, Poznan, Poland * These authors contributed equally to this work Correspondence to: Dominik Dytfeld, email: dytfeld@icloud.com Keywords: multiple myeloma, bortezomib, label-free proteomics, iTRAQ, thioredoxin Received: June 08, 2016 Accepted: July 20, 2016 Published: August 04, 2016 ABSTRACT Identifying biomarkers of the resistance in multiple myeloma (MM) is a key research challenge. We aimed to identify proteins that differentiate plasma cells in patients with refractory/relapsed MM (RRMM) who achieved at least very good partial response (VGPR) and in those with reduced response to PAD chemotherapy (bortezomib, doxorubicin and dexamethasone). Comparative proteomic analysis was conducted on pretreatment plasma cells from 77 proteasome inhibitor naive patients treated subsequently with PAD due to RRMM. To increase data confidence we used two independent proteomic platforms: isobaric Tags for Relative and Absolute Quantitation (iTRAQ) and label free (LF). Proteins were considered as differentially expressed when their accumulation between groups differed by at least 50% in iTRAQ and LF. The proteomic signature revealed 118 proteins (35 up-regulated and 83 down-regulated in ≥ VGPR group). Proteins were classified into four classes: (1) involved in proteasome function; (2) involved in the response to oxidative stress; (3) related to defense response; and (4) regulating the apoptotic process. We confirmed the differential expression of proteasome activator complex subunit 1 (PSME1) by enzyme-linked immunosorbent assay. Increased expression of proteasomes and proteins involved in protection from oxidative stress (eg., TXN, TXNDC5) plays a major role in bortezomib resistance.

Introduction: Non-Hodgkin lymphomas are characterized by monoclonal malignant proliferation of B or T lymphoid cells, rarely NK. The objective of the study was to determine the main difficulties in the management of patients being followed for non-Hodgkin lymphoma. Methodology: This was a descriptive cross-sectional study carried out at the Hematology Department of the Conakry University Hospital. It took place over a period from January 2015 to September 2019. It consisted of data collection from the records of patients meeting the inclusion criteria during the study period. Results: We included 49 cases in which NHL accounted for 51.12% of all hematological malignancies. The M/F sex ratio was 2.11. The mean age was 43 years with extremes of 17 and 75 years. The most affected age group was 45-59 years of age. Diagnosis was made on the basis of: histology (93.88%), immunohistochemistry (4.08%), cytology (2.04%). The diagnostic delay was less than 6 months (10.20%), between 6 and 12 months (42.85%) and more than 12 months (46.95%). The most frequent histological type was diffuse large cell lymphoma (41%), followed by Burkitt lymphoma (20.41%) and marginal zone lymphoma (19%). Treatment was mainly CHOP21 (61.02%), COP (14.28%), and the rest of the patients were untreated. For those treated, the therapeutic plan was respected in 38.25% of cases. Conclusion: Diagnostic delay, unavailability of immunohistochemistry and specific drugs, low socioeconomic status, and illiteracy for some patients were the main problems found in the management of non-Hodgkin lymphoma in our exercise setting.

Our aim was to retrospectively investigate the real-world outcome and healthcare costs associated with the treatment of patients with relapsed or refractory multiple myeloma (RRMM) in a Chinese single center.A retrospective study was conducted for 93 patients between January 2008 and December 2013 in a Chinese hematology department. Total monthly costs attributable to each cost component were described across all regimens and for bortezomib-based treatment regimens.Mean total cost per patient-month ($1139.85) varied depending on the sequence of therapy (range: mean $51.63-$6600.96). Drugs and hospital visit were the most and the least consumed resource (65.48% and 2.87%, respectively). Mean total monthly costs were $2071.96 (range: $679.73-$6600.96) and $551.14 (range: $51.63-$1698.59) for patients receiving bortezomib and patients not receiving bortezomib, respectively. Differences between the two groups were significant for drugs; drugs costs were higher for patients treated with bortezomib. Kaplan-Meier curves showed a longer overall survival (mean [median] 31.43 [25] vs. 21.93 [18] months) for patients treated with bortezomib.Real-world costs during treatment of RRMM varied greatly. Total costs during bortezomib-based regimens are significantly higher compared with non-bortezomib regimens. Further multi-center studies are needed to assess the cost-effectiveness of bortezomib for the treatment of RRMM in China.

The increasing prevalence of Klebsiella pneumoniae carbapenemase 2-producing K. pneumoniae (KPC-2-KP) infections can become a new life-threatening complication for hematological patients. Five cases of KPC-2-KP bloodstream infections have been identified in our hematology department over the past 10 years. The current treatment options do not show satisfactory efficacy, especially for bloodstream infections. The treatment of these five cases was unsuccessful, mainly due to the high minimum inhibitory concentrations of carbapenem, fosfomycin resistance, or the inaccessibility of polymyxin. Further investigations into the optimal treatment modalities are therefore imperative. The present study provides insights into the epidemiology and clinical challenges of treating KPC-2-KP bloodstream infections.

Cohort Profile: The Jerusalem Perinatal Family Follow-Up Study Gabriella M. Lawrence, David S. Siscovick, Ronit Calderon-Margalit, Daniel A. Enquobahrie, Einat Granot-Hershkovitz, Susan Harlap, Orly Manor, Vardiella Meiner, Ora Paltiel, Pui-Yan Kwok, Yechiel Friedlander and Hagit Hochner* Braun School of Public Health, Hebrew University-Hadassah Medical Center, Jerusalem, Israel, New York Academy of Medicine, New York, NY, USA, Cardiovascular Health Research Unit, Department of Epidemiology, University of Washington, Seattle, WA, Departments of Psychiatry and Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA, Department of Human Genetics, Hebrew University-Hadassah Medical Center, Jerusalem, Israel, Hematology Department, Hebrew University-Hadassah Medical Center, Jerusalem, Israel, Institute for Human Genetics, Cardiovascular Research Institute and Department of Dermatology, University of California, San Francisco, CA, USA

Aim of the study: to evaluate the long term response to rituximab in patients with chronic and refractory immune thrombocytopenia purpura (TIP) after failure of conventional therapy, and study response to retreatment with rituximab. Material and methods: 41 patients with chronic or refractory ITP were registered in hematology department in Tripoli medical center /Libya treated with rituximab. Patients received 375mg/m2 of rituximab weekly for 4 weeks. Response was defined as platelets increase to more than 50x109/l. Results: 41 patients were included in this study. Mean age was 42 years. 32/41(78%) were female and 9/41(22%) were males. Mean platelets count before rituximab was 26x109/l , mean platelets count after rituximab treatment 115x109/L.( 46.5%) of patients had complete response , (12%) had partial response and (41.5 %) had no response. 5 patients of previously responder had received repeated dose of rituximab,3/5(60%) showed complete response and 2/5 (40%) has no response . Rituximab was well tolerated and show relatively short term toxicity. Conclusion: rituximab is a long term safe and effective alternative treatment for chronic ITP patients. Repeated dose can be used in previously responding patients.

[Introduction] There are limited findings available on KIT-negative GIST-like (KNGL) population. Also, KIT expression may be post-transcriptionally regulated by miRNA221 and miRNA222. Hence, the aim of this study is to characterize KNGL population, by differential gene expression, and to analyze miRNA221/222 expression and their prognostic value in KNGL patients., [Methods] KIT, PDGFRA, DOG1, IGF1R, MIR221 and MIR222 expression levels were determined by qRT-PCR. We also analyzed KIT and PDGFRA mutations, DOG1 expression, by immunohistochemistry, along with clinical and pathological data. Disease-free survival (DFS) and overall survival (OS) differences were calculated using Log-rank test., [Results] Hierarchical cluster analyses from gene expression data identified two groups: group I had KIT, DOG1 and PDGFRA overexpression and IGF1R underexpression and group II had overexpression of IGF1R and low expression of KIT, DOG1 and PDGFRA. Group II had a significant worse OS (p = 0.013) in all the series, and showed a tendency for worse OS (p = 0.11), when analyzed only the localized cases. MiRNA222 expression was significantly lower in a control subset of KIT-positive GIST (p < 0.001). OS was significantly worse in KNGL cases with higher expression of MIR221 (p = 0.028) or MIR222 (p = 0.014)., [Conclusions] We identified two distinct KNGL subsets, with a different prognostic value. Increased levels of miRNA221/222, which are associated with worse OS, could explain the absence of KIT protein expression of most KNGL tumors., The project was funded by the Instituto de Salud Carlos III (ISCIII) - Fondo Europeo de Desarrollo Regional (FEDER), through a public competitive call (project reference PI15/01254; principal Investigator Javier Martín Broto), and the Spanish Group for Research on Sarcoma (GEIS).

International audience; Key Clinical Message Images of parasitic forms of Leishmania infantum are typical in the hands of a skilled expert but should be known by biologists of Hematology Department. In an endemic region, the diagnosis of visceral leishmaniasis (VL) must be considered because of its potential role in accelerating hematological malignancy.

Summary Hospital environment is considered the main source of invasive aspergillosis (IA) in leukemic patients. This study aimed to describe Aspergillus colonisation in leukemic patients and their hospital environment and to test whether Aspergillus environmental contamination was associated with IA. For a 2-year period including 14-month renovation work, 91 acute leukaemia inpatients at the hematology department of University hospital in Sousse (Tunisia) were prospectively included. The incidence of probable IA (EORTC/MSG criteria) was 9.9%. Fifty-six Aspergillus were isolated from 53 (6.5%) of 811 sputa collected from 35 (38.5%) patients. Aspergillus spp. were isolated in 59.7% of 494 air samples and in 52.8% of 1579 surface samples taken in the patients' room. Aspergillus section Nigri (72.7%) was the most frequent. Aspergillus contamination peaked in autumn and winter on surface and in summer and autumn in air samples and was higher (P = 0.03) during the renovation work period. Multivariate analysis showed that for each Aspergillus section Nigri CFU airborne contamination IA risk increased by 1.05 (P = 0.04). In Tunisia, Aspergillus section Nigri and Flavi, but not Fumigati, are chiefly involved in IA. Our findings support swift implementation of airborne fungal contamination control measures in areas where immunocompromised patient are hospitalised.

Background: Pancytopenia is a common hematological parameter detected in Hematology department. It is important to find out the etiology of pancytopenia for the better management of patient. Pancytopenia represents a wide range of age groups and most pancytopenia is purely of bone marrow dysfunction origin. However, other causes such as hypersplenism and SLE are also frequently encountered. Objectives: To differentiate various causes of pancytopenia, to evaluate the hematological parameters in pancytopenic cases, and to analyze clinical manifestations in cases of pancytopenia. Materials and Methods: There were 25 admitted cases of pancytopenia at Affiliated Hospital of Dali University between the calendar year 2013 and 2014. A detail study was done on the basis of age, gender, clinical features, typical laboratory investigations, bone marrow examination, and final diagnosis. Results and Conclusions: Among 25 cases studied, megaloblastic anemia was the common cause of pancytopenia and incidence of megaloblastic anemia was higher in males after 5th decade of life. Pancytopenic cases age was ranging from 15 to 80 years. Fatigue and dizziness were the most common clinical features presented.

Aim: Chronic myeloid leukemia (CML) is a BCR-ABL positive myeloproliferative disorder characterized by clonal proliferation of the hematopoietic stem cells. Imatinib mesylate represents the most important agent associated with improved survival in CML that has been introduced for clinical use in 2000s. The original imatinib preparation Glivec ® was subsequently followed by the introduction of biosimilar products containing a variety of excipients. Gastrointestinal side effects represent the major limitation for therapeutic use of imatinib. This study was planned to examine whether excipients in the original and biosimilar imatinib products had any role in the emergence of GIS side effects. Materials and methods: Excipients in imatinib preparations used for the treatment of chronic phase (CP) CML patients followed up and treated at the hematology department of Mersin University between 2000 and 2019 were analyzed with respect to their potential GIS side effects. Results: Totally 42 CML patients included in the study. The median age was 53.2, and female:male ratio was 20:22. They had similar demographic characteristics as compared to previously reported CML populations. No patients had GIS side effect requiring drug discontinuation or switch to another agent. While bovine gelatin and polyvinyl alcohol had no significant effects on GIS side effects, those that contained titanium were found to be associated with a significant increase in the risk of GIS side effects (52%, contained titanium vs 0/2, contained no titanium). These side effects are less frequently in products that have lowest number of excipient types. Conclusion: GIS side effects can be triggered by various excipients in imatinib preparations.

Primary testicular lymphoma(PTL) is an uncommon extranodal presentation constituting 1% of all NHL and 5% of all testicular neoplasm. The objective of our study was to identify the presenting signs and symptoms, treatment and outcome of patients with testicular lymphoma diagnosed atthe Hematology department of Farhat Hached University Hospital from 1997 to 2007 and to perform bibliography review about this pathology. Eleven cases were identified; the median age was 61 years (range:31-83).All patients presented with testicular and s crotal swelling or mass.B symptoms (recurrent fever of>38∫C temperature, night sweets and unexplained weight loss of>10% of the body weight within six months prior to diagnosis) were present in 6 patients. According to the

Objective. To investigate the factors influencing readmission of 4778 patients who were readmitted within 31 days, in 2012, of an A-level tertiary general hospital in Beijing. Methods. Indices, including the patient's basic condition distribution, payment mode and disease constitution, etc. were analyzed with SPSS statistical software. Results. The rate of readmission of females was obviously higher than that of males; the readmission rates of patients covered by medical insurance (18.6%) and the free medical service (14.5%) were significantly higher than those of other types of patients; and the readmission rate of 60 to 69-year-old patients was 20.6%, being the highest. The departments with the top three readmission rates were respectively the oncology department (63.1%), the rehabilitation department (59.4%) and the hematology department (54.9%), and the top three diseases were respectively tumor (58.5%), circulatory system disease (10.1%) and respiratory disease (9.9%). Conclusions. The major ...

We report a case of hemoglobin (Hb) Willamette (β51 Pro → Arg) in the Hematology Department of a tertiary hospital in Fortaleza, Northeast of Brazil. A literature review of the cases described in health sciences databases using as a descriptor Hb Willamette was performed, revealing 12 reported cases, of which only one presented with anemia. Herein, we describe a case of a female 29 years old, with hemoglobinopathy Willamette presenting clinically with anemia, having the lowest hemoglobin rate of the published cases. The relatives of the patient were evaluated andthe patient’s mother corresponded to the first description of the association between Hb Willamette and HbC. Among the hemoglobinopathies, hemoglobin Willamette is an extremely rare disease; therefore it is important to analyze its clinical and laboratory manifestations for accurate diagnosis and assessment of potential interactions with other genetic variants.

The sternoclavicular joint is an uncommon location for chondrocalcinosis (calcium pyrophosphate deposition disease). A 66-year-old man, known for chondrocalcinosis in the ankle, was hospitalized in the Hematology Department on the suspicion of myelodysplasia. A bone marrow examination was performed, and 48 h later, anterior chest wall pain appeared with an inflammatory syndrome (C-reactive protein 60 mg/l) without fever. Clinical …

Comparatively to open repair, endovascular aneurysm repair has reduced transfusion rates but thereâs no recommendation about number of red blood cells units to be crossmatched preoperatively. Our aim is contribute to the analysis of red blood cells units needs in endovascular and hybrid aortic aneurysm repair and developing a protocol for maximum surgical blood orders schedule.We retrospectively analyzed our prospective database of elective endovascular aneurysm repair from 2001 to 2012. We analyzed patients' age, gender, ASA classification, maximum surgical blood orders schedule, red blood cells units transfused and timings, types of endoprosthesis, red blood cells units consumption/endoprosthesis' type ratio, crossmatch to transfusion ratio, conversion to open repair, hemoglobin concentrations before surgery and discharge.We selected 187 patients, 90% men, mean age 73.1, ASA mode III. The endoprosthesis were aorto-bi-iliac in 71%, aorto-uni-iliac in 23% and thoracic in 6%. Of these, 72,6% of the patients did not require blood transfusion. We transfused 171 red blood cells units. Crossmatch to transfusion ratio was 10.1 until 2010 and 7.3 after. The ratio of red blood cells units consumption/endoprosthesis in the first 24 hours was 0.21 red blood cells units/aorto-bi-iliac, 0.46 red blood cells units/aorto-uni-iliac, 0.8 red blood cells units/thoracic, 1.3 red blood cells units/hybrid-thoracic and 2 red blood cells units/hybrid-aorto-bi-iliac. A statistical correlation was observed between red blood cells units transfused postoperatively and type of endoprosthesis (p0.001) and between ASA classification and red blood cells units transfused after 24 hours (p0.01).Guidelines from the British Society of Haematology are based on a crossmatch to transfusion ratio of 2:1. Our crossmatch to transfusion ratio was 10.1 until 2010 and 7.3 from 2011 to 2012.These results changed our policy of maximum surgical blood orders schedule for endovascular aneurysm repair. We now type and screen aorto-bi-iliac and aorto-uni-iliac. We crossmatch two red blood cells units for thoracic, three red blood cells units for hybrid thoracic and four red blood cells units for hybrid abdominal procedures. This may lead to financial savings, improved efficiency and reduce workload in hematology department.Introdução: O tratamento endovascular dos aneurismas da aorta reduziu as taxas de transfusão. Não existem recomendações relativamente às unidades de glóbulos vermelhos a serem tipadas por crossmatch pré-operatoriamente. O nosso objetivo é contribuir para a análise das unidades de glóbulos vermelhos necessárias no tratamento endovascular dos aneurismas da aorta e na cirurgia híbrida de aneurismas da aorta e definir um protocolo do Maximum Surgical Blood Orders Schedule. Material e Métodos: Analisámos retrospetivamente a base de dados prospectiva dos doentes tratados eletivamente por tratamento endovascular dos aneurismas da aorta, entre 2001 e 2012. Analisamos idade, género, classe ASA, Maximum Surgical Blood Orders Schedule, unidades de glóbulos vermelhos transfundidas e tempos, endoprótese, relação unidades de glóbulos vermelhos consumidas/endoprótese, relação unidades crossmatched/transfundidas, conversão para cirurgia convencional, hemoglobina pré-operatória e na alta. Resultados: Selecionamos para análise 187 doentes, 90% homens, idade média 73,1, classe ASA III mais frequente. Usamos próteses aorto-bi-iliaca em 71%, aorto-uni-iliaca 23% e torácica 6%. Não necessitaram transfusão 72,6%. Transfundimos 171 unidades de glóbulos vermelhos. A relação unidades crossmatched/transfundidas foi 10,1 até 2010 e 7,3 após. A relação unidades de glóbulos vermelhos consumidas/endoprótese nas primeiras 24 horas foi 0,21 unidades de glóbulos vermelhos/aorto-bi-iliaca, 0,46 unidades de glóbulos vermelhos/aorto-uni-iliaca, 0,8 unidades de glóbulos vermelhos/torácica, 1,3 unidades de glóbulos vermelhos/híbrida-torácica e duas unidades de glóbulos vermelhos/híbrida-aorto-bi-iliaca. Obtivemos relação estatisticamente significativa entre unidades de glóbulos vermelhos transfundidas/endoprótese (p0,001) e entre classificação ASA e unidades de glóbulos vermelhos transfundidas após 24 h (p0,01). Discussão: As recomendações da British Society of Haematology baseiam-se numa relação unidades crossmatched/transfundidas de 2:1. Na nossa instituição, a relação unidades crossmatched/transfundidas foi de 10,1 até 2010 e 7,3 de 2011 a 2012. Conclusões: Os resultados mudaram o nosso Maximum Surgical Blood Orders Schedule para o tratamento endovascular dosaneurismas da aorta. Atualmente procedemos ao teste 'type and screen' para próteses aorto-bi-iliaca e aorto-uni-iliaca e a testes de crossmatch de duas unidades de glóbulos vermelhos para torácica, três para híbrida-torácica e quatro para híbrida-abdominal. Isto pode levar a menos gastos, aumento de eficácia e reduzir a sobrecarga no departamento de hematologia.

Rationale We describe a novel case of half-brothers suffering from type 2 familial hemophagocytic lymphohistiocytosis (FHL). Patient concerns A 15-year-old Chinese child was admitted to the hematology department. PRF1 gene coding revealed that he was c.282C>A/p.N94K heterozygous and had a c.1349C>T/p.T450M heterozygous mutation. One year later, his younger halfbrother suffered from the same disease. PRF1 gene coding revealed that the younger brother was c.282C>A/p.T450M heterozygous with a c.1349C>T/p.T450M heterozygous mutation. His mother and grandfather were confirmed to have c.1349C>T/p.T450M heterozygous mutations in exon 3. Diagnoses Half-brothers were diagnosed for type 2 familial hemophagocytic lymphohistiocytosis INTERVENTIONS:: To our knowledge, this is a possible FHL and the children's mother may be a pathogenic gene carrier. Outcomes After being treated with the HLH-04 schedule, the symptoms of half-brothers were all improved. Lessons subsections Therefore, once FHL is diagnosed, HSCT needs to be done early, even if no perfect match is found.

Aim: Chemotherapy-induced febrile neutropenia (FN) predisposes patients to life-threatening infections and typically requires hospitalization. Patients with profound neutropenia have increased risk of septicemia associated with significant morbidity. To provide the appropriate broad-spectrum antimicrobial cover, documentation of causative agents and their antimicrobial susceptibilities should be established in each hospital. Methods: The goal of the present study was to investigate the causative microorganisms in 27 febrile neutropenic patients between January 2006 and December 2007. Results: ln our hematology unit, among 122 febrile neutropenic episodes 57 isolates from cultures of febrile neutropenic patients, gram-negative bacteria was prevalent (45.6%). Among the gram-positives (%42.1% of isolates) coagulase-negative staphylococci (CNS) were the predominant bacteria (13/23) followed by Staphylococcus aureus (7/23). Escherichia coli (14/26) and Klebsiella spp. (7/26) were the most common species among 26 gram-negative bacteria. Conclusion: The most important issue in febrile neutropenia is still a mortal situation in immunocompromised patients. So documentation of the flora in each unit would help to decide appropriate empirical therapy which is life saving.

PURPOSE/OBJECTIVES To describe, from an interdisciplinary perspective, how cancer-related symptoms are assessed and managed in a cancer care setting and to describe the components that influence symptom management. DESIGN Descriptive, qualitative, and cross-sectional. SETTING An oncology and hematology department in a university hospital in western Sweden. SAMPLE 31 nurses, physicians, physical therapists, dietitians, occupational therapists, and a medical social worker who all cared for patients with cancer-related symptoms. METHODS Data were collected in focus groups and analyzed using content analysis. MAIN RESEARCH VARIABLES Cancer-related symptoms and symptom management. FINDINGS Symptom management, from a clinician's perspective, is a process involving different components. Four themes emerged from the data analysis: creating a relationship with the patient, understanding the patient, assessing the symptoms, and cooperating as a team. CONCLUSIONS This study highlights several components that should be discussed in an effort to enhance symptom management. Discussion will help ensure that barriers to effective symptom management are acknowledged and addressed when implementing clinical routines designed to enhance management of different symptoms. In addition, these components should be acknowledged in the interest of facilitating adherence to symptom management strategies. Whether these components are important factors from patients' perspectives remains unknown. IMPLICATIONS FOR NURSING Enhancing symptom management is not only a matter of implementing clinical guidelines; it must be preceded by teamwork, assessment, and evaluation method discussions and the ability to create a relationship with the patient. Nurses should be aware that their understanding of a patient affects their assessment of that patient's symptom experience.

// Cristina Bilbao-Sieyro 1,2 , Yanira Florido 1 and Maria Teresa Gomez-Casares 1 1 Hematology Department, Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain 2 Morfology Department, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain Correspondence to: Maria Teresa Gomez-Casares, email: // Cristina Bilbao-Sieyro, email: // Keywords : CALR, myeloproliferative neoplasms, type-1/2-like mutations Received : March 23, 2016 Accepted : June 13, 2016 Published : July 01, 2016 Abstract Identification of somatic frameshift mutations in exon 9 of the calreticulin gene (CALR) in myeloproliferative neoplasms (MPNs) in December of 2013 has been a remarkable finding. It has provided a new molecular diagnostic marker, particularly in essential thrombocythemia (ET) and primary myelofibrosis (PMF), where is the second most common altered gene after JAK2V617F. There are two main types of CALR mutants, type 1 and type 2, and there is evidence about their distinct clinical/prognostic implications, for instances, it is believed that favorable outcome might be restricted to type-1 in PMF. By using reasoned approaches, very recent publications have supported classifying the alternative mutants in type-1-like or type-2-like. If further studies confirm these results, new considerations may be taken into account in the molecular diagnosis of MPNs. This implies that precise mutation characterization must be performed and caution should be taken in screening technique selection. In this Editorial we summarize the current information regarding all this issues.

Patients with chronic lymphocytic leukemia (CLL) harboring TP53 aberrations (TP53abs; chromosome 17p deletion and/or TP53 mutation) exhibit an unfavorable clinical outcome. Chromosome 8 abnormalities, namely losses of 8p (8p-) and gains of 8q (8q+) have been suggested to aggravate the outcome of patients with TP53abs. However, the reported series were small, thus hindering definitive conclusions. To gain insight into this issue, we assessed a series of 101 CLL patients harboring TP53 disruption. The frequency of 8p- and 8q+ was 14.7% and 17.8% respectively. Both were associated with a significantly (P < 0.05) higher incidence of a complex karyotype (CK, ≥3 abnormalities) detected by chromosome banding analysis (CBA) compared to cases with normal 8p (N-8p) and 8q (N-8q), respectively. In univariate analysis for 10-year overall survival (OS), 8p- (P = 0.002), 8q+ (P = 0.012) and CK (P = 0.009) were associated with shorter OS. However, in multivariate analysis only CK (HR = 2.47, P = 0.027) maintained independent significance, being associated with a dismal outcome regardless of chromosome 8 abnormalities. In conclusion, our results highlight the association of chromosome 8 abnormalities with CK amongst CLL patients with TP53abs, while also revealing that CK can further aggravate the prognosis of this aggressive subgroup., This work has been supported by the following grants: PI11/01621, PI15/00437, RD09/0076/00036, RD12/0036/0044, RD12/0036/0069 and PT13/0010/0005 FEDER, Instituto de Salud Carlos III, Spanish Ministry of Economy and Competitiveness; 2014/SGR585 from Generalitat de Catalunya; “Xarxa de Bancs de tumors” sponsored by Pla Director d'Oncologia de Catalunya (XBTC) and Fundació La Caixa; the Swedish Cancer Society, the Swedish Research Council, the Lion's Cancer Research Foundation, and Selander's Foundation, Uppsala; H2020 “AEGLE, An analytics framework for integrated and personalized healthcare services in Europe” by the EU.