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INTRODUCTION: Essential thrombocythemia (ET) is an entity of classic Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs), characterized by thrombocytosis with megakaryocytic hyperplasia where in the thrombocytes are increased with abnormal function. Thrombotic events are seen frequently and represent the main cause of morbidity and mortality in patients with MPNs, mainly polycythemia vera and ET. This study has aimed to research the effects of clonally increased thrombocytes on plasma viscosity (PV) levels among patients with ET and the relationship between PV and thromboembolism history, according to the hypotheses about the effects of PV in thromboembolic events among patients with ET. METHODS: A total of 55 patients were enrolled in the study group, 18 of who had been newly diagnosed with ET according to 2016 World Health Organization criteria and had not previously been treated. 37 of them had already been diagnosed with ET and had been treated. There were 47 healthy volunteers in the control group. 5 cc blood samples were taken from the patients into tubes including an anticoagulant to measure their PV levels. RESULTS: PV of the control group was found to be lower than in the study group and both each patient groups (p

There are only a few predictive markers that can truly aid therapy decisions in patients with acute myeloid leukemia (AML). The current study aimed to examine the impact of easily available common laboratory parameters on the course and prognosis of patients with AML. Gender, initial bone marrow blast percentage, mean platelet volume (MPV), lymphocyte-to-monocyte ratio, treatment regimen, and complete remission (CR1) were found to have a statistically significant effect on both OS and PFS (

Background Hairy cell leukemia is a rare B-cell lymphoproliferative disorder. It has an indolent course with relapse and remission periods. The aim of this study was to investigate the clinical characteristics and risk factors affecting the outcome of patients with hairy cell leukemia. Patients and Methods The retrospective data of 65 patients were evaluated according to initial hematologic and biochemical parameters, response rates, progression-free survival, and overall survival. Factors effecting response and survival rates were analyzed. Results The median follow-up duration was 62.8 months (range, 5.7-229.3 months). The result of the analysis showed that the patients with relapse/progressive disease had higher lactate dehydrogenase (LDH) levels at the time of diagnosis than patients without relapse/progression (median [range], 243 [137-540] vs. 179 [99-334] U/L, P = .01). Patients with LDH ≥ 200.5 IU at the time of diagnosis were demonstrated to have a shorter progression-free survival than those with LDH Conclusion Serum LDH level is significantly associated with relapse/progression in hairy cell leukemia patients. Patients with higher LDH levels at diagnosis should be monitored closely even if they experience complete remission.

Background The programmed death receptor (PD-1) and ligand (PD-L1) pathway act by suppressing the antitumor response in chronic Hodgkin lymphoma (cHL). In this study, we aimed to investigate the effect of PD-1, PD-L1, and Epstein-Barr virus (EBV) positivity on prognosis at the initial diagnosis of cHL. Material and Methods Thirty-six patients with cHL were retrospectively analyzed. PD-L1 staining was performed for RS cells and tumor microenvironment in the biopsy materials of cases. The presence of EBV was investigated by EBER (EBV-encoded RNA) method in tumor cell. P Results The presence of advanced-stage disease, B symptoms, intermediate or high-risk international prognostic index (IPS), and extranodal involvement were found to be related to both PD-L1 positivity and EBV positivity in RS cells. PD-L1 positivity in RS cells was also associated with EBV positivity. There were 6 (16.7%) triple-positive (EBV+, RS-PD-L1+, mic-PD-1+) patients. All of these patients had advanced-stage disease, B symptoms at the time of diagnosis, and intermediate-high IPS score, and 4 of 6 patients had extranodal involvement. This group also had significantly shortened overall survival compared with others (38.4 months vs. 67.9 months P = .024). Conclusion Our data suggest that there is correlation between PD-L1 positivity and EBV positivity in tumor RS cells that are also associated with extranodal involvement, intermediate and high IPS score, presence of B symptoms, and advanced-stage disease. In addition, we identified a group of triple-positive (EBV+, RS-PD-L1+, mic-PD-1+) cHL patients who have a very high-risk disease.

Introduction Vitamin D, which is known for its effects on calcium and bone metabolism, has recently been associated with haematological malignancies. We aimed to investigate the relationship between disease findings and vitamin D deficiency in essential thrombocythemia (ET) and polycythemia vera (PV). Material and Methods This retrospective cohort study conducted in Turkey included 73 patients diagnosed with PV or ET according to WHO criteria between 2012 and 2018. Vitamin D deficiency was defined as 25-OH vitamin D < 20 ng/mL. Polymerase chain reaction (PCR) was used to detect the Janus kinase 2 (JAK2) V617F mutation. Results Vitamin D deficiency was found in 66.7% of PV and 74.2% of ET patients. The median follow-up time of ET and PV patients was 48 months and 47 months, respectively. Patients with the JAK2 mutation had a higher prevalence of a history of thrombosis and age older than 65 years. There was a significant relationship between JAK2 positivity and vitamin D deficiency. Conclusion There was a remarkably higher prevalence of vitamin D deficiency in JAK2 mutation-positive ET and PV patients. These patients should be carefully evaluated for vitamin D deficiency. More studies are required to further investigate the association between JAK2 and vitamin D.

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma (NHL) and comprises a heterogeneous group of disease. While classification of B-cell lymphomas has been evolving to include clonality in a specific manner, morphology, and immunohistochemistry remain the backbone. We aimed to evaluate the value of CD5 expression on disease characteristics as well as prognosis in patients with DLBCL. Data of 131 patients with DLBCL with CD5 positivity and as a comparison arm, data of 129 patients with DLBCL without CD5 positivity were evaluated. Mean age was 59 and 55.7% of the patients were male. Overall survival was 29.8 months. Poor prognostic factors including (high-LDH levels, B symptoms, low ECOG score, high R-IPI and NCCN-IPI score) were observed to be significantly related with CD5 positivity. Mean survival in CD5 positive patients were 29.8 months, which is significantly shorter than the general DLBCL survival worldwide. CD5 expression shall be evaluated in all samples of DLBCL patients due to its possible effects on outcomes. © 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Background: Diffuse large B-cell lymphoma (DLBCL) is the most common sub-type of Non-Hodgkin lymphomas (NHL) and it is a very heterogeneous group of diseases. CD5 positivity is profound in a substantial patient population in DLBCL. In this population, female patient distribution is higher, LDH elevation, extra nodal involvement, bone marrow involvement, ECOG (Eastern Cooperative Oncology Group) performance score elevation and high international prognostic score (IPI> 2) are more frequent for CD5 - DLBCL. Also, it was observed that prognosis of CD5 + DLBCL was worse than CD5 - DLBCL. We aimed to determine the frequency of CD5 positivity in DLBCL in Turkey with this multicenter study.Methods: The study, in order to get the overall parts from Turkey, including from each geographical area, 16 center and 9 cities were included. Each center retrospectively scanned the diagnostic pathology reports of DLBCL patients between January 2015-2021.Results: Two thousand four hundred sixty-nine DLBCL patients were screened retrospectively. CD5 positivity was detected in 169 patients (6.84%). The average age was 59 and 55.7% of the patients were male. Overall survival was 29.8 months. When evaluated with historical data in this group of patients, poor prognostic factors were found to be more common than CD5 - DLBCL patients.Conclusion: Due to its prognostic effect, immunohistochemically, the presence of CD5 in pathological samples of all DLBCL patients should be checked. The effect on prognosis in this patient group should not be forgotten while treatment and follow-up.

Chronic lymphocytic leukemia (CLL) is a common hematological malignancy. This study is aimed to investigate the prognostic effect of clinic, laboratory and flow cytometric analysis in CLL patients. Newly diagnosed 55 CLL cases were divided into two groups, as stable disease (Group 1) and progressive disease (Group 2). Group 1 included those who did not require any treatment since diagnosis and those who did not progress after receiving the first step anti CLL treatment. Group 2 included the patients who received ≥ 2 steps treatment. The relation between the two groups was analyzed statistically in terms of clinical, laboratory and flow cytometric findings. Twenty patients (36.3%) required treatment at the time of diagnosis, four patients (3.8%) received first-line treatment during follow-up and 31 (56.3%) patients were followed without any treatment. Thirteen patients required second step treatment after a median of 26.3 months. The risk of progression was found to be increased 5-fold (p = 0.015) in the CD38 positive patient group, 4.2-fold (p = 0.0147) in the FMC7 negative patient group and 2.8-fold in the CD11c negative patient group. FMC 7 negativity decreased total survival 5.9-fold (p = 0.051). Unlike similar publications, we found that patients with CD11c or FMC7 negativity were in a higher need for ≥ 2 step treatment. This suggests that CD11c or FMC7 negativity may be used as a poor prognostic marker in CLL.

Introduction Dasatinib is a potent tyrosine-kinase inhibitor which is used for chronic myeloid leukemia treatment. Pleural effusion is a frequent side effect in patients during dasatinib treatment. Pulmonary arterial hypertension is a rare and life-threatening adverse event of dasatinib. The relationship between dasatinib and autoimmune disorders is unclear, but there are reports of possible mechanisms that have triggered autoimmunity by dasatinib. Case report A 53-year-old male was diagnosed with chronic myeloid leukemia and initiated imatinib mesylate as a treatment. Imatinib was changed to dasatinib as the patient was unresponsive in the first year of treatment. In the fourth year of dasatinib when chronic myeloid leukemia was in both hematological and cytogenetical remission, the patient presented with bilateral massive exudative pleural effusion. Echocardiography was consistent with pericardial effusion with right ventricle enlargement and normal left-side cardiac function. Pulmonary arterial hypertension was diagnosed with high systolic pulmonary arterial pressure. When he had fever and arthralgia, further investigation showed positivity of anti-nuclear antibodies (1/160 titer) and anti-RNP/Sm, which have high specificity for the diagnosis of Systemic Lupus Erythematosus (SLE). Management and outcome Dasatinib was discontinued and nilotinib was initiated. As the pleural effusion persisted despite diuretics and methylprednisolone, mycophenolate mofetil was initiated as a steroid-sparing immune-suppressive agent. The lupus-like symptoms disappeared, and antibodies became undetectable after dasatinib discontinuation. Pericardial effusion improved and pleural effusion did not relapse. Discussion Screening for auto-antibodies may be recommended for patients with a history or symptoms of autoimmune disease before starting dasatinib. All patients who develop pleural effusion while on dasatinib treatment should be investigated for antibodies for lupus.

This study aimed to show the status of thioldisulphide homeostasis in essential thrombocytosis patients, which is known to play a role in platelet function.The study included 27 ET patients and a control group of 36 healthy subjects. Serum total (-SH + -S-S-) and native (-SH) thiol levels were measured in all subjects using an automatic method.Age and gender distribution were similar in both groups. Compared with the control group, in the ET group, there were increased native thiol and total thiol levels (p = 0.001, p = 0.046). There was no correlation between thiol, total thiol and disulphide ratios with Jak2 mutation, hemorrhage and thrombosis. A positive correlation was determined between thrombosis and thiol disulphide homeostasis (p = 0.058). The study results showed that thiol-disulphide homeostasis shifted to the proliferative side in ET, in which ineffective erythropoiesis was predominant. It is also known that platelets are more active in ET cases and thiol disulphide balance is important in platelet function.This result suggests that thrombotic complications may be reduced if the formation is achieved of mechanisms (oxidation mechanisms) that will trigger the increase of disulphide groups. However, more extensive research is needed on this subject.Ova studija je imala za cilj da pokaže stanje homeostaze tiol-disulfida kod pacijenata sa esencijalnom trombocitozom, za koje je poznato da imaju ulogu u funkciji trombocita.Studija je obuhvatila 27 ET pacijenata i kontrolnu grupu od 36 zdravih subjekata. Izmereni su serumski ukupni (–SH + –S–S–) i prirodni (–SH) nivoi tiola kod svih subjekata koristeci automatsku metodu.Distribucija starosti i pola bila je slična u obe grupe. U poređenju sa kontrolnom grupom, u ET grupi povecani su izvorni tiol i ukupni nivoi tiola (p = 0,001, p = 0,046). Nije bilo korelacije između tiola, ukupnog tiola i disulfidnih racija sa Jak2 mutacijom, krvarenjem i trombozom. Utvrđena je pozitivna korelacija između tromboze i tiol-disulfidne homeostaze (p = 0,058). Rezultati studije pokazali su da se tiol-disulfidna homeostaza pomera na proliferativnu stranu u ET, u kojoj je dominantna neefikasna eritropoeza. Takođe je poznato da su trombociti aktivniji u ET slučajevima, a da je balans tiol-disulfida važan u funkciji trombocita.Ovaj rezultat sugeriše da se trombotičke komplikacije mogu smanjiti ako se postigne formacija mehanizama (oksidacionih mehanizama) koji ce izazvati povećanje disulfidnih grupa. Međutim, potrebno je detaljnije istraživanje o ovoj temi.

Plasma cell leukemia (PCL) is a rare and an aggressive form of plasma cell dyscrasias. We report a 67-year-old male with PCL which developed while on imatinib mesylate (IM) therapy 38 months after diagnosis of chronic myeloid leukemia (CML). The patient has been treated successfully with bortezomib, melphalan and prednisolone. To our knowledge, only one case of PCL superimposed on Philadelphia positive CML has been reported in the literature and this was before the IM era.

Objectives Myelodysplastic syndrome (MDS) is a highly mortal disease in which anemia is unresponsive to treatment. In this study, the effect of basal ferritin values on prognosis and survival was investigated in MDS patients without history of transfusion. Methods Data were retrospectively analyzed for 62 MDS cases. The cases were divided into two groups according to ferritin values. Results The mean survival time was 61.1 ± 4.8 months. During the follow-up period, 34 (54.8%) patients deceased. Median ferritin level was 358 ng/mL. The serum ferritin (SF) level associated with mortality was determined as 400 ng/mL (ROC area for SF was 0.731 with a cutoff value of 400; sensitivity and specificity were 70.7% and 68.2%, respectively) (P = 0.002). There were 29 (46.8%) patients with serum ferritin levels of ≥ 400 ng/mL. Patients with serum ferritin levels ≥ 400 ng/mL had low survival rates. Ferritin ≥ 400 ng/mL was associated with six times increased mortality (P = 0.001). Conclusion Although the acceptable ferritin level at the start of chelation therapy is 1000 ng/mL, the fact that 400 ng/mL value is associated with survival in our study suggests that it may be useful to start chelation therapy in the early period. Further case studies on the subject are required.

Acute promyelocytic leukemia is characterized by the presence of atypical promyelocytes in bone marrow and peripheral blood. Neoplastic promyelocytes, which often have Auer rods, are most commonly seen in early myeloid precursors in certain subtypes of myeloid leukemia. A 63-year-old male patient,was admitted to our clinic with the complaints of malaise and weight loss for several months, presented with leucopenia and mild anemia. There were no findings of organomegaly, lymphadenopathy and bleeding diathesis and no evidence of infection. Bone marrow aspiration and biopsy which was performed with the preliminary diagnosis of myelodysplastic syndrome revealed a slightly increased Myeloid/Erythroid ratio, distinct maturation arrest in the cells of myeloid lineage 15-20% of which have nucleocytoplasmic asynchrony, course cytoplasmic granules and Auer rods. Auer rods were also present in the cytoplasm of mature neutrophils. Additionally, megakaryocytes were also dysplastic. The immunohistochemical staining was positive for CD117 in 10% of the cells and there was no staining for CD34. The diagnosis was obscure until the fluorescein in situ hybridization results which was positive for PML-RARa fusion t(15;17) (q24.1;q21.2) was received. The patient was eventually diagnosed with acute promyelocytic leukemia. This unusual case of APL was characterized with rarity of atypical promyelocytes in the bone marrow, distinct dysplasia in the myeloid and megakaryocytic lineages and silent clinical course without coagulopathy which caused delay in diagnosis, and well response to treatment.

Background: Thiol-disulphide homeostasis has vital role in cell signalling mechanisms, regulation of transcription factors and enzymatic activities, signal transduction and regulation of proliferation rate, apoptosis and detoxification and antioxidant protective mechanism.Objective: This study aims to demonstrate in Polycythemia Vera (PV) patients the thioldisulphide homeostasis which is known to play a role in cell proliferation, apoptosis and various steps of cell cycle.Design: Descriptive prospective cross-sectional study.Settings: Yildirim Beyazıt University Hospital Ankara, Turkey between 2016-2018.Method: Forty-two PV patients and 43 healthy controls were included in the study. Serum total (–SH + –S–S–) and native (–SH) thiol levels were measured in all subjects. The amount of dynamic disulphide bonds and, the ratio of (–S–S–) and (–S–S–) × 100/(–SH), (–S–S–) × 100/(–SH + –S–S–), and –SH ×100/(–SH + –S–S–) were calculated with automatic method. The data obtained from the patient group were compared with the control group.Main outcome measures: The amount of dynamic disulphide bonds and, the ratio of (–S–S–) and (–S–S–) × 100/(–SH), (–S–S–) × 100/(–SH + –S–S–), and –SH ×100/(–SH + –S–S–) were calculated with automatic method in PV patieint and healthy control group. Results: Both groups were similar in terms of age and gender distribution. Compared with the control group, PV group had significantly higher native thiol, total thiol and nativ/total thiol levels.Limitation: The generalizability of the study's findings were limited by the small sample size.Conclusions: In accordance with the nature of the disease, thiol balance in PV patients was in favor of proliferation. Increased total thiol (–SH + –S–S), native thiol (–SH) levels and native thiol/total thiol ratio might be associated with uncontrolled proliferation. The balance of the thiol-disulphide homeostasis shifted to reductive thiol side in the PV. This change can provocate proliferation status of the disease and/or may be secondary to the disease.Conflict of Interest: No conflict of interest was declared by the authors.&nbsp

Amac: Nedeni bilinmeyen ates (NBA) etiyolojisi cogu zaman klinisyenleri ugrastiran, tani icin invaziv islemler gerektiren klinik bir tablodur. Kemik iligi kulturu ve biyopsisi ile lenf nodu biyopsisi bu amacla tercih edilen invaziv girisimlerdir. Calismamizda NBA etiyolojisi arastirdigimiz hastalarimiza ait bu incelemelerin tanidaki rolu ve sonuclari tartisilmistir. Materyal ve Metot: Ankara Ataturk Egitim ve Arastirma Hastanesi Enfeksiyon Hastaliklari Klinigi’nde NBA etiyolojisine yonelik kemik iligi (KI) kulturu ve biyopsisi amaci ile Hematoloji ile konsulte edilen ve lenf nodu biyopsisi degerlendirilen hastalar incelenerek, tanida bu invaziv girisimlerin rolu degerlendirilmistir. Bulgular: Kemik iligi kulturu-biyopsisi yapilan 18 erkek, 14 kadin, toplam 32 hastadan alinan kemik iligi kulturlerinin altisinda ureme saptandi. Iki hastada es zamanli olarak hem kan, hem de kemik iligi kulturunde ureme vardi. Iki hastanin sadece kemik iligi kulturunde Brucella spp. uredi.Kemik iligi biyopsilerinden 24’u (%75,00) normoseluler, 6’si (%19,00) hiperseluler, biri (%3,00) lenfoma tutulumu gosteren kemik iligi ve bir digeri ise poliklonal plazma hucre artisi gosteren hiposeluler kemik iligi seklinde raporlandi. Fizik muayenede lenfadenopatisi saptanan dokuz hastaya lenf nodu biyopsisi yapildi. Lenf nodu biyopsileri ile bir hastada Leishmania spp., bir hastada EBV ve iki hastada diffuz buyuk B hucreli non-Hodgkin lenfoma (NHL) saptandi. Sonuc: NBA etiyolojisinde kemik iligi biyopsisi ve kulturu ve lenf nodu biyopsisi invaziv tanisal girisimler olup, kemik iligi tutulumu ile seyreden brusella gibi zoonotik enfeksiyonlar basta olmak uzere losemi, lenfoma, tuberkuloz gibi durumlari ortaya koymada altin standart testtir. NBA etyolojisi arastirilirken girisimsel hematolojik islemlerin degeri goz ardi edilmemelidir. Birinci basamak hekimleri, bu islemlerin gerekliligi ve zamanlamasi konusunda bilgi sahibi olmalidir.

Background: Chronic myeloproliferative diseases are clonal stem cell diseases which occur as a result of uncontrollable growth and reproduction of hematopoietic stem cells, which are the myeloid series source in bone marrow. Recent studies have suggested that chronic inflammation can be a triggering factor in the clonal change in chronic myeloproliferative neoplasia (CMPN). In our study, we evaluated the existence of a chronic inflammation process in our Philadelphia negative (Ph-)CMPN patients using inflammation parameters in combination with demographic, laboratory and clinical characteristics of the patients. Materials and Methods: Demographic characteristics, clinical and laboratorial data, and thrombosis histories of 99 Ph-CMPN patients, who were diagnosed at our outpatient clinic of hematology in accordance with WHO 2008 criteria, were analyzed retrospectively,with 80 healthy individuals of matching gender and age included as controls. Complete blood counts, sedimentation, C reactive protein (CRP), JAK V617F gene mutations, abdomen ultrasound images and previous thrombosis histories of these patients were retrospectively analyzed. Results: Ph-CMPN and healthy control groups included 99 and 80 cases, respectively. PV, ET and MF diagnoses of patients were 43 (%43.4), 44 (44.4%) and 12 (12.1%), respectively. JAK V617F gene mutation was found to be positive in 64 (71.1%) of all cases and in 27(65.8%), 32 (82%), 5 (50%) of the cases in PV, ET and PMF groups, respectively. Thrombosis was determined as 12 (12%) in the entire group, 12.5% in the JAK V617F negative and 15.3% in the positive patients, with no statistical significance (p=0.758). No significant difference was observed between patients with and without previous thrombosis history in respect to hemogram parameters, sedimentation and CRP (p>0.05), neutrophil to lymphocyte ratio (NLR), erythrocyte distribution width (RDW), mean platelet volume (MPV) and sedimentation levels of the patient.

The etiology of cerebral hemiatrophy may be congenital or acquired. Trauma, infection, vascular abnormality, ischemic and hemorrhagic conditions may be the etiologic factors in acquired type. There is limited information about its association with other disorders in the literature. We presented three new cases of cerebral hemiatrophy associated with some hematological and developmental disorders. Cerebral hemiatrophy was associated with thalassemia major in a 10-year-old girl, acute myeloblastic leukemia and Marfan syndrome in a 23-year-old man, and craniosynostosis in a 1-year-old boy. To the best of our knowledge, thalassemia major, myeloblastic leukemia, Marfan syndrome and craniosynostosis have not been reported in cerebral hemiatrophy in the literature. (J Pediatr Neurol 2004; 2(3): 171-174).

Acquired hemophilia A (AHA) which presents with spontaneous severe intramuscular, mucosal and/or subcutaneous bleeding is a rare bleeding disorder. Even 50% of AHA patients are defined as idiopathic; 10% of cases are related with malignancy. Here, we present a case of AHA in a 43-year-old lady who was diagnosed with malignancy and venous thromboembolism on vena cava 2 years ago. To the best of our knowledge, this is the first report in literature presented with both acquired hemophilia and thrombosis associated with malignancy. A routine workup for malignancy like solid tumors, lymphoproliferative, or myeloproliferative diseases should be performed and followed up for a long time despite clinical improvement for individuals presented with AHA. Moreover, because of warfarin treatment, the diagnosis may be difficult and delayed. Clinicans should rule out AHA in patients who are on warfarin treatment and have abnormal coagulation tests.

Amaç:Nedeni bilinmeyenateş (NBA) etiyolojisi çoğu zaman klinisyenleriuğraştıran, tanı için invaziv işlemler gerektiren klinik bir tablodur. Kemikiliği kültürü ve biyopsisi ile lenf nodu biyopsisi bu amaçla tercih edileninvaziv girişimlerdir. Çalışmamızda NBA etiyolojisi araştırdığımızhastalarımıza ait bu incelemelerin tanıdaki rolü ve sonuçları tartışılmıştır.Materyal ve Metot: AnkaraAtatürk Eğitim ve Araştırma Hastanesi Enfeksiyon Hastalıkları Kliniği’nde NBA etiyolojisineyönelik kemik iliği (Kİ) kültürü ve biyopsisi amacı ile Hematoloji ile konsülteedilen ve lenf nodu biyopsisi değerlendirilen hastalar incelenerek, tanıda buinvaziv girişimlerin rolü değerlendirilmiştir.Bulgular: Kemik iliği kültürü-biyopsisi yapılan 18 erkek, 14 kadın,toplam 32 hastadan alınan kemik iliği kültürlerinin altısında üreme saptandı.İki hastada eş zamanlı olarak hem kan, hem de kemik iliği kültüründe üremevardı. İki hastanın sadece kemik iliği kültüründe Brucella spp. üredi.Kemik iliği biyopsilerinden 24’ü (%75,00) normoselüler, 6’sı (%19,00) hiperselüler,biri (%3,00) lenfoma tutulumu gösteren kemik iliği ve bir diğeri ise poliklonalplazma hücre artışı gösteren hiposelüler kemik iliği şeklinde raporlandı. Fizikmuayenede lenfadenopatisi saptanan dokuz hastaya lenf nodu biyopsisi yapıldı. Lenf nodu biyopsileri ile birhastada Leishmania spp., bir hastadaEBV ve iki hastada diffüz büyük Bhücreli non-Hodgkin lenfoma (NHL) saptandı.Sonuç: NBA etiyolojisinde kemik iliği biyopsisi ve kültürü ve lenf nodu biyopsisiinvaziv tanısal girişimler olup, kemik iliği tutulumu ile seyreden brusellagibi zoonotik enfeksiyonlar başta olmak üzere lösemi, lenfoma, tüberküloz gibidurumları ortaya koymada altın standart testtir. NBA etyolojisi araştırılırkengirişimsel hematolojik işlemlerin değeri göz ardı edilmemelidir. Birincibasamak hekimleri, bu işlemlerin gerekliliği ve zamanlaması konusunda bilgisahibi olmalıdır., Objectives: Fever of unknown origin (FUO) is a usually challenging clinical condition for physicians. The diagnostic work-up requires invasive procedures including culture of bone marrow aspirates and bone marrow/lymph node biopsies. In this study, we have investigated the results of diagnostic procedures employed for the work-up of FUO.Materials and Methods: Patients who were requested hematological consultation for bone marrow aspiration for culture during the work-up for FUO in the Infectious Diseases Department of Ankara Atatürk Training and Research Hospital were included in the study. Patients with detected lymphadenopathies during physical examination had also underwent pathological investigation of bone marrow and lymph node biopsies.Results: Bone marrow cultures revealed positive results in 6 out of 32 patients(18 male and 14 female). Two patients had simultaneous positivity of both blood and bone marrow cultures. Brucella spp. was detected in bone marrow cultures of two other patients. Among the bone marrow biopsies 24(75.00%) were normocellular, 6(19.00%) were hypercellular, 1(3.00%)revealed lymphoma involvement and 1(3.00%) revealed polyclonal expansion of plasma cells. Nine patients with with lymphadenopathies in physical examination were performed lymph node biopsies. Lymph node biopsies demonstrated Leishmania spp. in 1 patient, EBV in 1 patientand diffuse large B-celllymphoma in 2 patients.Conclusion: Bone marrow biopsy and culture and lymph node biopsy are invasive diagnostic tests for the work-up of FUO. Bone marrow culture is the golden standard for the diagnosis of zoonotic infections including brucellosis and granulomatous infections including tuberculosis, as well as infiltration with leukemia and lymphoma. The value of interventional hematological procedures should not be underestimated during the work-up of FUO. The primary care physicians must be aware of this necessity and of the timing for these procedures.

The aim of this study was to determine the effect of high-dose methylprednisolone (HDMP) on lymphocyte subtypes, CD4/CD8 ratio and clinical efficacy of the treatment in children with acute immune thrombocytopenic purpura (ITP). The study consisted of 21 children (aged between 1.5-14 years) with ITP treated with HDMP for 7 days. Absolute lymphocyte count, CD4+ and CD8+ T lymphocyte levels were examined on peripheral blood and CD4/CD8 ratio was calculated before and after HMTP treatment (on 0 and 8th days) in all subjects. There was no statistically significant difference for age and sex between the study and the control group. A significant reduction was observed in the percentage of CD4+ lymphocyte (39.0 ± 7.5% vs 29.3 ± 8.1%, p= 0.001), CD8+ lymphocyte (27.1 ± 7.2% vs 23.7 ± 8.3%, p= 0.03), CD4+/CD8+ (1.5 ± 0.5 vs 1.3 ± 0.4, p= 0.02) and the absolute number of CD4+ lymphocyte count (1694.99 ± 1019 vs 1199.12 ± 612, p= 0.038). These findings indicated that HDMP treatment may cause a decrease in the percentage of CD4+ and CD8+ T-lymphocyte and ratio of CD4+/CD8+ lymphocyte in patients with acute ITP. We suggest that the effectiveness of steroids may depended upon the suppression of CD4 T-lymphocyte and sequential monitoring of circulating lymphocyte subtypes may be used to predict the clinical effects of steroid treatment.Bu çalışmanın amacı; akut immüntrombositopenili (iTP) çocuklarda kullanılan yüksek doz metilprednizolon (YDMP) tedavisinin lenfosit alt tiplerine, CD4/CD8 oranına etkisini ve klinik etkinliğini saptamaktır. Bu çalışma yedi gün süreyle YDMP ile tedavi edilen, yaşları 1.5-14 yıl arasında değişen 21 çocuğu kapsamaktadır. Tanı anında ve YDMP tedavisinden sonra absolü lenfosit sayısı, CD4+ ve CD8+ T-lenfosit sayısı çalışıldı ve CD4/CD8 oranı hesaplandı. Çalışma grubu ve kontrol grubu arasında yaş ve cinsiyet açısından anlamlı fark yoktu. YDMP tedavisi sonunda CD4+ lenfosit yüzdesinde (%39.0 ± 7.5 vs %29.3 ± 8.1, p= 0.001), CD8+ lenfosit yüzdesinde (%27.1 ± 7.2 vs %23.7 ± 8.3, p= 0.03), CD4/CD8 oranında (1.5 ± 0.5 vs 1.3 ± 0.4, p= 0.02) ve absolü CD4 lenfosit sayısında (1694.99 ± 1019 vs 1199.12 ± 612, p= 0.038) anlamlı azalma görüldü. Bu bulgular göstermiştir ki akut iTP`li hastalarda YDMP tedavisi CD4+ ve CD8+ T-lenfosit sayısını ve CD4/CD8 lenfosit oranını azaltmaktadır. Steroid etkisinin CD4 lenfositlerinin baskılanmasına bağlı olabileceğini ve steroid tedavisinin etkinliğinin belirlenmesinde lenfosit alt tiplerinin monitörizasyonunun kullanılabileceğini düşünüyoruz.

Infections caused by hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency viruses (HIV) remain the leading most important health problems worldwide. Screening tests such as HBsAg, anti-HCV, anti-HIV and VDRL are mandatory tests to look at before transfusion of blood or blood components. In this study, donors who applied to our Blood Center in a nine-year period were retrospectively evaluated with respect to HBsAg, anti-HCV, anti-HIV and syphilis seroprevalence. HBsAg, anti-HCV and anti-HIV were examined by microparticle ELISA system, and syphilis antibodies were screened by a syphilis test device. Of the total 39,002 individuals, 16,601 (42%) were females and 22,401 (58%) were males. HBsAg positivity was found in 2.55%, anti-HCV in 0.17%, anti-HIV in 0.036%, and VDRL in 0.057% of overall donors. As a result, HBsAg, anti-HCV, anti-HIV and VDRL seropositivity rates in donors living in our region were found lower than those in many regions of Turkey. Nevertheless, because there is no screening method to reduce the risk resulting from transfusion to zero, it appears that it is essential to adopt strict criteria in the selection of donors and to avoid unnecessary transfusion.İnsan bağışıkyetmezlik virusu (HIV), Hepatit B ve Hepatit C virüslerinin neden oduğu infeksiyonlar halen önde gelen en önemli sağlık problemi olmaya devam etmektedir. HBsAg, anti-HCV, anti-HIV ve VDRL gibi tarama testleri kan ürünleri veya kan transfüzyonlarından önce bakılması zorunlu testlerdir. Bu çalışmada, kan merkezimize 9 yıl içinde başvuran dönorler HBsAg, anti-HCV, anti-HIV ve sifiliz seroprevalansı açısından retrospektif olarak değerlendirildi. HBsAg, anti-HCV, anti-HIV ELİSA mikropartikül sistemi ile incelenirken sifiliz antikorları ise sifiliz test cihazı ile tarandı. Toplam 39.002 kişiden 16.602 (%42)’si kadın ve 22.401 (%58)’i de erkekti. HBsAg, tüm donörlerin %2.55’inde pozitif olarak bulunurken, anti-HCV, anti-HIV ve VDRL pozitifliği sıra ile tüm dönorlerin %0.17, %0.036, %0.057’sinde pozitifti. Sonuç olarak bölgemizde yaşayan donörlerdeki HBsAg, anti-HCV, anti-HIV ve VDRL seropozitifliği Türkiye’de bulunan çoğu bölgelerdekinden daha düşük bulundu. Yine de transfüzyondan kaynaklanan riskleri azaltıp sıfıra indirecek her hangi bir tarama metodu bulunmaması nedeni ile, gereksiz transfüzyonlardan kaçınılmasına ve donör seçiminde daha dikkatli davranılmasına ihtiyaç vardır.

Objectives: The etiology of multiple myeloma (MM) is not exactly known. This study investigated the role of thiol/disulfide homeostasis in the etiopathogenesis of MM. Methods: Some 50 patients with MM (aged 39–84 years) and 50 sex-matched healthy volunteer controls (aged 50–91 years) participated in this study. Venous blood samples were collected, and levels of native thiols, total thiols, and disulfide were measured. Results: Native and total thiol levels in the control group were determined to be higher than in the study and patient groups (P0.05). Discussion: The results of the study show that although there was a decrease in the levels of disulfide, native thiol, and total thiol, the balance of thiol/disulfide was maintained. This is the first study to research the homeostasis of dynamic thiol/disulfide from the perspective of the new method that was used. We hope that this study will encourage and facilitate further studies in this area.

Background: Utilizing geriatric screening tools for the identification of vulnerable older patients with cancer is important. The aim of this study is to evaluate the hospitalization risk of elderly hematologic cancer patients based on geriatric assessment and laboratory parameters. Materials and Methods: In this cross sectional study 61 patients with hematologic malignancies, age 65 years and older, were assessed at a hematology outpatient clinic. Standard geriatric screening tests; activities of daily living (ADL), instrumental activities of daily living (IADL), Mini Nutritional Assessment (MNA), Mini Mental State Examination (MMSE), timed up and go test (TUG), geriatrics depression scale (GDS) were administered. Demographic and medical data were obtained from patient medical records. The number of hospitalizations in the following six months was then recorded to allow analysis of associations with geriatric assessment tools and laboratory parameters. Results: The median age of the patients, 37 being males, was 66 years. Positive TUG test and declined ADL was found as significant risk factors for hospitalization (p=0.028 and p=0.015 respectively). Correlations of hospitalization with thrombocytopenia, vitamin B12 and folic acid deficiency were statistically significant (p=0.004, p=0.011 and p=0.05 respectively). Conclusions: In this study, geriatric conditions which are usually unrecognized in a regular oncology office visit were identified. Our study indicates TUG and ADL might be use as predictive tests for hospitalization in elderly oncology populations. Also thrombocytopenia, and vitamin B12 and folic acid deficiencies are among the risk factors for hospitalization. The importance of vitamin B12 and folic acid vitamin replacement should not be underestimated in this population.

Purpose Neutrophil-to-lymphocyte ratio (NLR) was evaluated as a potential prognostic factor in patients with myelodysplastic syndrome (MDS). Materials and methods Between December 2009 and April 2014, 14 female (35%) and 26 male (65%) MDS patients who were followed up in our hematology clinic were included in the study for NLR during diagnosis. Division was into two groups according to the NLR, and the correlation with mortality was evaluated. The prognostic significance of NLR regarding treatment outcome was also evaluated with adjustment for known confounding risk factors. Results The mortality rate of the patient group was 55%, and median survival was 18 months. There was no significant correlation between mortality and NLR at a median value of 1.8 (p=0.75). Thrombocytopenia was observed to increase mortality (p=0.027), and there was a significant correlation between mortality and pancytopenia (p=0.017). Conclusions This first study of NLR and mortality did not show any significant correlation . In centres with limited access to genetic evaluation for the presence of pancytopenia and/or thrombocytopenia at the time of diagnosis, a platelet level less than 50?109/l may be poor prognostic markers in MDS patients.

The incidence of hematological malignancies during pregnancy is low, and treatment in this setting is problematic. This study observed 21 pregnancies in 18 patients with hematological malignancies. Patients' ages were between 19 and 43 (median 25) years. Two pregnancies ended with spontaneous abortion, one pregnancy ended with in utero death, three therapeutic abortions were carried out, and 15 infants were born alive but three of them died later. The median birth weight was 2.47 kg. Twelve babies survived to a median age of 36 (range 4-117) months. Eight babies were exposed to chemotherapy during the in utero period. One baby was exposed to chemotherapy during all the trimesters and was born prematurely and later died because of intracranial bleeding. Four babies were exposed to chemotherapy during the first trimester, one of them had low birth weight and floating thumb malformation, two of them had only low birth weight, and one was born healthy, but died at 3 months of age as a result of severe gastroenteritis. Two babies were exposed to chemotherapy during the second and third trimesters; one of them had low birth weight, and the other pregnancy ended in in utero death. One infant was exposed to chemotherapy during the third trimester and was born at term, but died because of pulmonary hemorrhage. We concluded that chemotherapy during all trimesters of pregnancy carries a significant risk for an unfavorable outcome.

Lactic acidosis (LA) associated with hematologic malignancies is uncommon, life-threatening, and generally occurs in adults. Its pathogenesis is poorly understood. This is a case report of LA due to leukemic transformation that occurred in a patient with non-Hodgkin's lymphoma (NHL). A 24-year-old man with NHL was admitted to the hospital with dyspnea. Venous blood gas analysis revealed metabolic acidosis (pH 7.05; HCO3 6 mEq/L; BE 22 mmol/L; anion gap 28 mEq/L); the patient had an elevated plasma lactate concentration (12 mmol/L) and low glucose concentration (38 mg/dL). There was no reason other than leukemia-such as infection, circulatory failure, or drug use-for the development of severe LA. This case report shows that in patients with NHL, leukemic transformation may give rise to LA.