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Introduction and Objective: The Coronavirus 2019 (COVID-19) pandemic has affected many healthcare services as well as transfusion medicine practices. In this study, it is aimed to examine the early and late effects of the pandemic on the use and destruction rates of blood and blood components. Material and method: This retrospective study was conducted at a tertiary hospital transfusion center. Unit numbers of blood and blood components used and destroyed in 2018-2021 were grouped according to the pre-pandemic period (27 months), early pandemic period (6 months), and late pandemic period (15 months). Monthly use and disposals in the early and late pandemic periods were compared with the pre-pandemic period. Results: A total of 144114 units of blood and blood components were used. The most commonly used components were erythrocyte concentrate (EC), fresh frozen plasma (FFP) and thrombocyte concentrate (TC), respectively. Their monthly usages in the pre-pandemic period, the early pandemic period and the late pandemic period were 2067.1±147.2, 840±161.3 and 285.4±77.4; 1564.5±287.5, 576.7±146.2 and 261.5±52.6; 1803.5±122.1, 718.6±118.8 and 325.7±52.1; respectively. EC and FFP were used significantly less in the early and late pandemic periods than in the pre-pandemic period (p

Objective: Both the length of the treatment period and the diversity of the agents used in the treatment significantly affect the quality of life (QoL) of the patients with multiple myeloma (MM). With the aid of the EORTC Quality of Life Questionnaire Consisting of 30 Questions “EORTC QLQ-C30” and the Quality of Life Questionnaire Multiple Myeloma Module “QLQ-MY20”, we aimed to obtain data on quality of life in MM patients in a representative sample of the general population of our country. Methods: One hundred sixty eight patients from 6 different centers followed between 2018-2020 were included in the study. The QLQ-C30, and the QLQ-MY20 questionnaires specific for MM patients were used and the results were reported statistically. Results: Seventy eight (46%) of the patients were female, while 90 (54%) were male. The median age was 64 (22-84). When the findings were analysed, it was found that there was a greater effect on the symptom scale compared to the functional scale. Conclusion: The importance of the treatment-related side effect management, together with the adequate administration of appropriate symptomatic treatment in holistic treatment management were emphasized as effective factors in terms of the QoL of patients with MM.

Introduction: There is a paucity of data regarding the best practice to institute iv Daratumumab (D) in morbid obese patients regarding the infusion rate and duration, optimal dosing, and ideal way to cope with the infusion related reactions (IRR). We wanted to present the fi rst split dose D infusion experience in a morbid obese MM case whose D was interrupted because of a grade 3 IRR.

Introduction: Treatment of the elderly patients who have varying degrees of renal failure at the time of presentation, both due to the underlying plasma cell dyscrasia or the other comorbidities is a true challenge regarding the management of toxicities while trying to achieve the best durable responses. Daratumumab Lenalidomide and Dexamethasone (DRd) induction in transplant ineligible patient population is approved among the appealing results of MAIA trial. Lenalidomide is an immunomodulatory agent which is eliminated through kidneys and should potentially threat kidney function. But recently, PrE1003 trial showed that even patients with severe renal insuffi ciency should tolerate higher doses of the drug label.

Objective: Encapsulating peritoneal sclerosis (EPS) is a rare, but potentially fatal complication of peritoneal dialysis. Currently, treatment of peritoneal fibrosis is not fully possible yet. In this study, we aimed to demonstrate the effects of tacrolimus therapy on peritoneal fibrosis and inflammation when administered alone or with mycophenolate mofetil (MMF) in the EPS model induced in rats. Methods: Thirty six Wistar albino rats were separated into six equal groups. Group I was the control group. Group II-VI were administered intraperitoneal chlorhexidine (CH) for induced EPS model in rats. Group II, IV, V, VI were administered isotonic liquid, tacrolimus, tacrolimus and concurrently with CH, tacrolimus and MMF together, respectively. Group III was not administered any drug. All peritoneal samples were stained immunohistochemically with matrix metalloproteinase-2 (MMP-2) antibody. Thickness of peritoneal fibrosis, subserosal large collagen fibers, subserosal fibroblast proliferation and subserosal fibrotic matrix deposition were evaluated. Results: Comparing the experimentally induced EPS groups, the best histopathological results and the largest staining with MMP-2 were achieved in Group VI. Furthermore, in all treatment groups (IV, V, VI) more staining with MMP-2 was detected compared to non-treatment groups (I, II, III) but no statistically significant differences were found among all groups. A statistically significant remission was observed in all histopathological parameters, primarily peritoneal thickness in rats that were administered MMF with tacrolimus, compared to rats which were administered tacrolimus only. Conclusion: Concurrent use of tacrolimus and MMF in the treatment of EPS may be a promising approach. RESUMEN Objetivos: La esclerosis peritoneal encapsulante (EPE) es una complicación rara, peropotencialmente fatal de la diálisis peritoneal. Actualmente, el tratamiento de la fibrosis peritoneal aún no es posible. En este estudio, apuntamos a demostrar los efectos de la terapia con tacrolimus en la fibrosis peritoneal y la inflamación cuando se administran solos o con micofenolato de mofetilo (MMF) en el modelo EPE inducido en ratas. Métodos: Treinta y seis ratas Wistar albinas se separaron en seis grupos iguales. El Grupo I era el grupo de control. En los grupos II-VI se administró clorhexidina intraperitoneal (CH) para el modelo EPE inducido en ratas. En los Grupos II, IV, V, VI se administró respectivamente líquido isotónico, tacrolimus, tacrolimus y CH y finalmente tacrolimus y MMF juntos. El grupo III no recibió ningún medicamento. Todas las muestras peritoneales se tiñeron inmunohistoquímicamente con el anticuerpo Matrix Metaloproteinasa-2 (MMP- 2). Se evaluó el grosor de la fibrosis peritoneal, se evaluaron las fibras de colágeno grandes subserosas, la proliferación de fibroblastos subserosa y la deposición de la matriz fibrótica subserosa. Resultados: Comparando los grupos de EPE inducidos experimentalmente, los mejores resultados histopatológicos y la tinción con MMP- 2 más extensa se lograron en el Grupo VI. Además, en todos los grupos de tratamiento (IV, V, VI) se detectó más tinción con MMP-2 en comparación con los grupos de no tratamiento (I, II, III), pero no se encontraron diferencias estadísticamente significativas entre todos los grupos. Se observó una remisión estadísticamente significativa en todos los parámetros histopatológicos, principalmente el espesor peritoneal en ratas que recibieron MMF con tacrolimus, en comparación con las ratas que recibieron solo tacrolimus. Conclusión: El uso concurrente de tacrolimus y MMF en el tratamiento de EPS puede ser una aplicación prometedora.

Amaç: Vitamin B12 eksikliğinde gelişen ciddi megaloblastik anemili olguların parenteral yoldan tedavisi sırasında hipokalemi gelişebilir. Biz de şiddetli megaloblastik anemi tanısıyla parenteral yoldan tedavilerine başladığımız hastalarımızın serum potasyum seviyelerini ve EKG bulgularını değerlendirmeyi amaçladık. Materyal Metod: Çalışmaya 9 erkek, 11 kadın 20 hasta alındı. Ortanca yaş 66.5 yıldı. Olguların tedavi öncesi ve tedavinin üçüncü gününde serum potasyum düzeyleri ve EKG bulguları arasındaki farklar ‘bağımlı grupta t testi’ uygulanarak değerlendirildi. Normal dağılım göstermeyen değişkenler için ortanca (sıra değeri) kullanıldı. Sonuçlar: Tedavinin üçüncü gününde serum potasyum seviyesinde izlenen düşüş tedavi öncesi değerle karşılaştırıldığında anlamlı değildi, 4.56mmol/L e karşın 4.28mmol/l; p=0.062. PR aralığı tedavi öncesi ortalama 0.157±0.05sn (ortanca 155msn), tedavinin üçüncü gününde ortalama 0.167±0.02 sn (ortanca 160 msn); p=0.024 bulundu. Düzeltilmiş QT aralığı (QTc) tedavi öncesi ortalama 0.379±0.074 sn (ortanca 400 msn), tedavinin üçüncügününde ortalama 0.420±0.047sn (ortanca 400msn); p=0.890 bulundu. Tartışma: Hipokalemi, tedaviye erken yanıtta yeni hematopoietik hücrelerin üretimi nedeniyle potasyum kullanımındaki belirgin artıştan kaynaklanmaktadır. Çalışmamızda, tedavinin erken döneminde ortalama potasyum seviyesinde kısmi bir azalma ve EKG’de PR aralığında anlamlı uzama tespit etmiş olmamıza karşın klinik bulgular görülmemiştir, fakat yine de bu tür hastalar tedavi sırasında yakından izlenmelidir. Objective:WeevaluatedserumpotassiumlevelsandECGfindingsofpatientswithseveremegaloblasticanemiaundergoingparenteralvitaminB12treatmentduringwhichhypokalemiamaydevelop. MaterialandMethods:Ninemaleand11femalepatientswithmedianage66.5yearswereincludedinthestudy.SerumpotassiumlevelsandtheECGfindingswereevaluatedbeforeandonthethirddayofthetreatmentandthedifferencebetweenwasevaluatedbyt-testindependentgroups. Results:Therewasnostatisticaldifferencebetweenthemeanvaluesofserumpotassiumbeforetreatmentandafterthe3rddayofthetreatment:4.56mmol/Lvs4.28mmol/L;p=0.062.Bytheway,themeanvaluesofPRintervalandQTcwereasfollows:0.157±0.05sec(median155msec)vs0.167±0.02sec(median160msec);p=0.024and0.379±0.074sec(median400msec)vs0.420±0.047sec(median400msec);p=0.890.

Paroxysmal nocturnal hemoglobinuria (PNH) is a clonal stem cell disease that manifests with chronic intravascular hemolysis, thrombosis, and bone marrow failure. Various degrees of cytopenias accompany the disease. Although laboratory and clinical findings are similar, the disease may show different courses and require different treatments. Herein, we report two different courses of PNH with similar clinical and laboratory findings

OBJECTIVE: Acute myeloid leukemia (AML) is a hematological malignancy that frequently affects elderly population. With introducing the hypomethylating agents (HMAs) in elderly AML treatment, survival rates and quality of life have improved. However, long-term management in elderly and frail patients is still a challenge. In the present study, we aimed to determine whether HMA maintenance therapy is required until disease progression in frail and elderly AML patients by examining with a real-life data. METHODS: In a multicenter study, we analyzed non-promyelocytic elderly AML patients who were treated with first-line azacitidine or decitabine monotherapy in two different groups, retrospectively. While patients were treated with HMA until progression in the maintenance group, 6+3 cycles of azacitidine or decitabine were administered as a standard care of elderly AML patients in the non-maintenance group. Survival outcomes were compared between the groups. RESULTS: HMA therapy was maintained until progression in 20 patients, and HMA therapy was terminated after 6+3 cycles in 21 patients. Patients received a median of 6 (1–14) HMA cycles during follow-up time. The median 7.5 months of overall survival were observed (2–17 months) in maintenance and 3 months (1–13 months) in non-maintenance groups (p=0.001). CONCLUSION: Despite long-term exposure to HMA may appear as a risk factor for complications and toxicities in elderly and frail AML patients, the maintenance of therapy until disease progression provides a significant survival advantage. Therefore, we suggest that HMA therapy should continue until disease progression regardless the sort of HMA.

Rosai–Dorfman disease (RDD) is a rare and benign pathology of sinus histiocytosis of unknown etiology. Lymphadenopathy is the predominant clinical manifestation, but diverse organs can also be affected. Histological features involve S-100+ histiocytes with characteristic nuclear features within the enlarged sinusoids of the lymph nodes. The clinical course is unpredictable, but is often benign with spontaneous resolution of disease in most patients. We report a patient with bilateral massive enlargement of cervical, axillary, and inguinal lymph nodes, moderately enlarged spleen, and a weight loss of 15 kg. Excisional biopsy from the cervical lymph node showed that the dilated sinusoids were infiltrated by lymphocytes, plasma cells, and large histiocytes with CD 68 and S-100 protein positive. Due to the slow progression of the disease, oral prednisolone with a body weight of 1 mg/kg was started in March 2016. The steroid dosage has been adjusted many times during the clinical follow-up. After 33 months, steroid treatment resulted in partial shrinkage of lymph nodes, the spleen returned to its normal size, and the patient gained weight. After 38 months of follow-up, no systemic symptoms, sign, or extranodal involvement were detected, and the patient continued with low-dose steroid treatment.

Atthe present time, with the development of medicine, surgery and the use oftechnologically advanced modern drugs, many diseases, including kidneydiseases, have become treatable. Kidneytransplantation has become a treatment option for kidney diseases and kidneytransplant rates have increased as well as life expectancy has been prolongedby means of obtained success. Immunosuppressive drugs are used in theposttransplant treatment process of renal transplant patients. With the newtreatment options, it is aimed to increase the success rate of kidneytransplantation and also to eliminate the side effects which are caused by theuse of immunosuppressive drugs. Cellular therapies are one of the treatmentoptions that are studied for use in kidney transplantation. Regulator T cells,regulator B cells, regulator macrophages, dendritic cells, mesenchymal stemcells are cell sources that are searched and experimented for use in organtransplantation. It has been shown that successful results have been obtainedby using cell therapies in studies carried out with experimental animal modelsfor transplantation. In this review, cell therapies used in and candidatefor renal transplantation are discussed., Günümüzde,tıp, cerrahi alanında görülen gelişmeler ve teknolojik olarak geliştirilenmodern ilaçların kullanımıyla beraber, geçtiğimiz yüzyılda böbrek hastalıklarıda dahil olmak üzere, ölümcül olan birçok hastalık artık tedavi edilebilirkonuma gelmiştir. Böbrek nakli, elde edilen başarılar ile beraber, hem böbrek hastalıkları için bir tedaviseçeneği haline gelmiş ve böbrek nakil oranları artış göstermiş, hem debeklenen yaşam süresi uzamıştır. Böbrek nakli yapılan hastaların cerrahisonrası tedavi süreçlerinde immünsüpresif ilaçlar kullanılmaktadır. Yenigeliştirilmeye çalışılan tedavi seçenekleri ile hem böbrek naklinde elde edilenbaşarı oranı arttırılmaya çalışılmakta hem de immünsüpresif ilaçlarınkullanımının yol açtığı yan etkilerin giderilmesi amaçlanmaktadır. Hücreseltedaviler de böbrek naklinde kullanılması için üzerinde çalışılan tedaviseçeneklerinden bir tanesidir. Regülatör T hücreler, regülatör B hücreler, regülatörmakrofajlar, dendritik hücreler, mezenkimal kök hücreler, organ nakillerindekullanılması için araştırma ve deneme yapılan hücre kaynaklarındandır. Deneyhayvanlarında nakil modellerinde yapılan çalışmalarda, hücre tedavileri ilebaşarılı sonuçlar alındığı gösterilmiştir. Bu derlemede böbrek naklindekullanılan ve de kullanılmaya aday olan hücre tedavileri tartışılmıştır.

Hepatorenal syndromeis a reversible acute renal impairment that occurs in patients with advancedliver cirrhosis or fulminant hepatic failure. Terlipressin is a syntheticlong-acting analogue of vasopressin that is used in the treatment ofhepatorenal syndrome. Ischemic adverse events of the treatment with terlipressinhave been reported. We present a rare complication of terlipressin usage,ischemic skin necrosis of the scrotum, in a patient with advanced livercirrhosis and hepatorenal syndrome., Hepatorenal sendrom, ilerlemiş karaciğer sirozuveya fulminan karaciğer yetmezliği olan hastalarda ortaya çıkan, tersinir birakut böbrek yetmezliğidir. Terlipressin, hepatorenal sendromun tedavisindekullanılan sentetik uzun süre etkili bir vazopressin analoğudur. Terlipressinile tedavinin iskemik advers olayları bildirilmiştir. Karaciğer sirozu vehepatorenal sendromlu bir hastada terlipressin kullanımının nadir görülen birkomplikasyonunu, skrotumun iskemik cilt nekrozunu sunuyoruz.

The aim of the present study was to evaluate the efficacy and safety of eltrombopag, an oral thrombopoietin receptor agonist, in patients with chronic immune thrombocytopenia (ITP).A total of 285 chronic ITP patients (187 women, 65.6%; 98 men, 34.4%) followed in 55 centers were enrolled in this retrospective cohort. Response to treatment was assessed according to platelet count (/mmThe median age at diagnosis was 43.9±20.6 (range: 3-95) years and the duration of follow-up was 18.0±6.4 (range: 6-28.2) months. Overall response rate was 86.7% (n=247). Complete and partial responses were observed in 182 (63.8%) and 65 (22.8%) patients, respectively. Thirty-eight patients (13.4%) did not respond to eltrombopag treatment. For patients above 60 years old (n=68), overall response rate was 89.7% (n=61), and for those above 80 years old (n=12), overall response rate was 83% (n=10). Considering thrombocyte count before treatment, eltrombopag significantly increased platelet count at the 1Results of the current study imply that eltrombopag is an effective therapeutic option even in elderly patients with chronic ITP. However, patients must be closely monitored for response and side effects during treatment. Since both response and side effects may be variable throughout the follow-up period, patients should be evaluated dynamically, especially in terms of thrombotic risk factors.Bu çalışmanın amacı kronik immün trombositopeni (ITP) hastalarında bir oral trombopoietin reseptör agonisti olan eltrombopagın etkinlik ve güvenirliliğini değerlendirmektir.Elli beş merkezde izlem altındaki toplam 285 kronik ITP hastası (187 kadın, %65,6) bu geriye dönük küme çalışmasına alınmıştır. Tedaviye yanıt trombosit sayısına göre değerlendirilmiş ve tam yanıt (100.000/mmTanı anında yaş ortalaması 43,9±20,6 (3-95) yıl olan hastalar ortalama 18,0±6,4 (6-28,2) ay izlenmiştir. Tam ve kısmi yanıtı içeren toplam yanıt %86,7 (n=247) bulundu. Sırasıyla 182 (%63,8) ve 65 (%22,8) hastada tam ve parsiyel tedavi yanıtları gözlenmiştir. Otuz sekiz hasta (%13,4) eltrombopag tedavisine yanıt vermemiştir. Altmış yaş üzerindeki hastalarda (n=68) toplam yanıt %89,7 (n=61) bulunurken, bu oran 80 yaş üzerindeki (n=12) hastalarda %83 (n=10) olmuştur. Tedavi öncesi trombosit sayısı göz önüne alındığında, eltrombopag, tedavinin 1., 2., 3., 4. ve 8. haftalarında trombosit sayısını anlamlı şekilde artırmıştır. Kısmi veya tam cevap için gereken süre arttıkça, tedaviye cevap önemli ölçüde azaldığı saptanmıştır. Eltrombopag tedavisinden sonra maksimum trombosit sayısı ne kadar yüksekse, yan etkilerin oluşabilme ihtimalinin o kadar yüksek olabildiği dikkati çekmiştir. En sık görülen yan etkiler baş ağrısı (%21,6), güçsüzlük (%13,7) ve hepatotoksisite (%11,8) ve trombozdur (%5,9).Mevcut çalışmanın sonuçları, eltrombopag tedavisinin kronik ITP’de, yaşlı hastalar dahil olmak üzere, etkili bir tedavi seçeneği olduğunu göstermektedir. Bununla birlikte, hastalar tedavi sırasında yanıt ve yan etkiler açısından yakından izlenmelidir. Hem cevap hem de yan etkiler, takip süresi boyunca değişken olabileceğinden, hastalar özellikle tromboz risk faktörleri açısından dinamik olarak değerlendirilmelidir.

Giriş: Beta-talasemi major (?-TM) hastalarında hemosiderozise bağlı kalp yetmezliği sık görülmektedir. Kalp yetmezliğini erken dönemde tespit etmek için manyetik rezonans görüntüleme (MRI) yöntemi kullanılmaktadır. N-terminal beyin natriüretik peptid (NT-proBNP) kalp yetmezliğinin tanısında oldukça hassas bir belirteçtir. Bu çalışmamızda T2* skoruna göre kardiyak demir birikimi olmayan (CMRT2* > 20 msn) ?-TM hastalarında, kalp yetmezliğinin erken dönemde tanısında NT-proBNP'nin etkinliğini araştırdık.Yöntem: T2* > 20 ms olan 31 ?-TM hastası ve 25 sağlıklı kişide NT-ProBNP düzeyleri kemilüminesans yöntem ile ölçüldü.Bulgular: Hastaların NT-proBNP düzeyleri [ortanca: 33 (IQR: 28-94) pg/mL] ile kontrol grubu [ortanca: 41 (IQR: 28-59) pg/mL] arasında anlamlı bir fark tespit edilmedi. Hastaların 6'sında NT-proBNP düzeylerinin cut-off değerinin üzerinde olduğu belirlendi.Sonuç: MRI yöntemi ile kıyaslandığında NT-proBNP daha ucuz, ulaşılabilir ve girişimsel olmayan bir yöntemdir. Talasemi hastalarının aylık kontrollerinde dahi kolaylıkla uygulanabilir. T2* skoru normal olan hastaların bazılarında NT-proBNP düzeylerinin cut-off değerlerinden daha yüksek bulunması, NT-proBNP'nin kalp yetmezliğini erken dönemde tespit etmede daha hassas bir belirteç olduğunu göstermektedir Introduction: Heart failure due to hemosiderosis is frequent in beta-thalassemia major (?-TM) patients. Magnetic resonance imaging (MRI) is used in the early detection of heart failure. Amino-terminal pro-brain natriuretic peptide (NT-proBNP) is a very sensitive marker in the diagnosis of heart failure. In this study, we aimed to investigate the efficacy of NT-proBNP levels in thalassemia patients, who are thought to have no cardiac iron deposition according to T2* scoring system (CMRT2*?>?20 msn), in early identification of cardiac failure.Methods: NT-proBNP levels of 31 patients, who have T2*?>?20 ms, and of 25 healthy population were measured by chemoluminescence method.Results: NT-proBNP levels were not different in thalassemic patients [median: 33 (IQR: 28–94) pg/mL] compared to control group [median: 41 (IQR: 28–59) pg/mL]. We found that NT-proBNP level was above cut-off value in six patients.Conclusion: NT-proBNP is a cheaper, reachable, and noninvasive method compared to MRI technique, it can be easily used in monthly controls. Detection of highNT-proBNP levels above cut-off values in patients whose T2* values are normal indicates that measurement of NTpro-BNP is a more sensitive marker in early detection of cardiac failure.

0000-0001-9178-2850; WOS: 000406254200010 PubMed ID: 29033512 Background: Abnormal heart rate recovery (HRR) is predictive of cardiac mortality. Autonomic abnormalities in beta-thalassemia major (TM) patients have been reported in previous studies. However, the importance of low HRR in exercise stress test in TM patients has not yet been ascertained. Therefore, this study will be the first of its kind in the literature. Methods: Exercise stress test was performed on 56 TM patients who were being treated at the Thalassemia Center of our hospital, along with 46 non-TM iron deficiency anemia (IDA) patients as a control group. Values for HHR were recorded at 1, 2, 3, 4 and 5 min, and HRR was calculated by the difference of heart rate at peak exercise and at a specific time interval following the onset of recovery. Results: All HRR values were found to be lower in TM patients compared to those in the IDA group. Exercise capacity [metabolic equivalents (METs)] was also found to be low in these patients (p < 0.001) as well. Total exercise time was significantly lower in the TM group compared to the IDA group (8.40 +/- 1.7 min vs. 11.17 +/- 1.51 min, p < 0.001). Exercise capacity (METs) was also lower in the TM group compared to the IDA group. Mean T2* value was 28.3 +/- 13.7 ms in TM patients on magnetic resonance imaging (MRI). In addition, there are 18 TM patients with T2* value was < 20 ms. Conclusions: This study found that TM was independently associated with low HRR. Such a condition is an indicator of autonomic dysfunction in TM patients, since abnormal HRR is related to impaired autonomic response. In addition, impaired HRR may be a marker of early cardiac involvement in patients, whose T2* value is high on MRI. Modifying HRR with a cardiac rehabilitation program in TM patients with impaired HRR is a field open for further investigation.