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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

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.

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.

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.

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

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.

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.

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.

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.

Post Graduate Institute (PGI) Chandigarh is a premier institute of North India. There are approximately 70,000 admissions per year. The adult clinical hematology department sees more than 2000 new patients per year. A preliminary analysis of 299 chronic myeloid leukemia patients registered from January 2001 until December 2007 was done. Out of these, 256 (86%) patients were in chronic phase (CP). The median age at presentation was 40 years. At 6 months of follow-up 95% of patients who were started on Imatinib mesylate based therapy remained in CP. Partial cytogenetic remission was seen in 69% of patients while complete cytogenetic response was seen in only 20% of patients at 6 months on Imatinib mesylate.

The first hematology department in Morocco was created in Casablanca in 1980 and it is still the only public facility where adult patients can be treated for hematological diseases. Two other units treat pediatric hematological disorders and cancer. Some patients are treated in private clinics located primarily in Casablanca and Rabat. The public hospitals have very limited resources and rely heavily on nongovernmental organizations (NGOs) for the care of these patients. The NGOs have also played an important role in developing successful cooperative programs with hospitals and groups in Europe and the United States. Till 2004, all patients who needed BMT and could afford the cost went to Europe. In 2004, SCT was initiated in Casablanca, with a four-bed ward set up and properly equipped. By May 2007, 27 patients have received autologous PBSCs. With 15 patients in continuous CR, the program is considered a success so far. The development of allogeneic transplantation in Morocco planned in the current year is also considered a real challenge.

Purpose: To report ultrabiomicroscopy (UBM) evidence of choroid effusion as a cause of acute transient myopia in the onset of systemic lupus erythematosus.Design: Observational case report.Methods: A Caucasian 16-year-old girl was referred to the Hematology Department for progressive anemia, intermittent fever, and blurred vision.Results: Systemic lupus erythematosus was confirmed by hematological investigations. UBM examination evidenced choroid effusion as the cause of a transient myopic shift.Conclusions: Early diagnosis, thanks to the performance of an ultrasound examination, enabled the timely institution of therapy and hence a rapid resolution of the symptoms.

SCIENTIFIC MISCONDUCTBERN-- An expert panel has criticized Roland Mertelsmann, one of Germany's best known cancer researchers, for failing to detect data falsification and manipulation that allegedly occurred in his department and in some papers on which he was listed as a co-author. Responding to the findings, the rector of the University of Freiburg last week asked the state government to launch disciplinary proceedings. Mertelsmann, chief of the university medical center's oncology and hematology department, immediately called the inquiry "unfair" and vowed to mount a vigorous defense.

SummaryWe report the first occurrence of New Delhi metallo-β-lactamase 5 (NDM-5) in carbapenem-resistant Escherichia coli isolated from blood cultures of three leukemia patients in northern China. These patients had at some time been hospitalized in the hematology department of the same hospital. All isolates were ST167 with identical pulsed-field gel electrophoresis patterns, suggesting a likely hospital transmission.