Search

Key Clinical Message Waldenström's macroglobulinemia may begin with constitutional symptoms that are common in primary care settings and it is crucial for physicians to be aware of the potential complications of hyperviscosity syndrome and to employ the appropriate diagnostic methods in order to achieve better outcomes. Abstract Waldenström's macroglobulinemia (WM) refers to a type of lymphoplasmacytic lymphoma distinguished by the hyperproliferation of plasma cells, lymphocytes, and plasmacytoid lymphocytes. The disease is primarily diagnosed by increased monoclonal immunoglobulin M (IgM) levels and lymphoplasmacytic cell infiltration into the bone marrow. Individuals exhibit a high risk for hyperviscosity syndrome (HVS) as immunoglobulin levels increase. In addition to constitutional symptoms (fever, night sweats, and unintentional weight loss), clinical findings such as cytopenia, hepatosplenomegaly, and lymphadenopathy, this condition may cause hyperviscosity‐related organ failures. Here we discuss a patient with WM who presented with neurological complaints and blurry vision and developed necrosis at distal portions of his body during the 6‐month course of the disease.

Abstract The anticoagulants of choice for the prevention and treatment of venous thromboembolic disease during pregnancy are unfractionated heparin and low‐molecular‐weight heparin. Heparin‐induced thrombocytopenia (HIT) is introduced as a rare but critical side effect of heparin products raising the thromboembolic event paradoxically. Here, we present a case of HIT in pregnancy with challenging management due to coincidence of lupus anticoagulant (LA) and limited anticoagulant options in the pharmaceutical market of our country of residence. We describe a 6‐week pregnant patient with deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE), which developed HIT during antenatal care. Therapeutic anticoagulation was initiated with argatroban, then switched to apixaban due to limited access to argatroban. Another therapeutic challenge was the concurrent incidence of LA. The interdisciplinary care team decided on adding up warfarin and scheduled termination at 12 weeks regarding the hazardous condition of the patient. We also reviewed related case literature to convey a new insight into managing pregnancy‐related HIT. HIT is a pro‐coagulatory and lethal complication associated with heparin therapy that can be diagnosed by clinical suspicion, the 4T score system, and confirmatory laboratory analyses. Alternative anticoagulation is the cornerstone of the treatment and an interdisciplinary plan will be worthwhile to make the best clinical decision regarding the critical situation and least the thromboembolic events mortality during pregnancy.

Key Clinical Message This case report emphasizes that we should analyze a patient's signs and symptoms as a whole rather than relying exclusively on a common pattern to diagnose the condition and indicates that thorough histological investigation and sample collection are needed to accurately diagnose this malignancy. Abstract Angiosarcoma is a rare, fatal, and poorly understood malignant tumor of vascular endothelial cells which is a challenging disease to diagnose in the clinical settings and requires early diagnosis to achieve a favorable prognosis. Paraneoplastic syndromes associated with angiosarcoma can include hypercoagulability, thrombocytopenia, anemia, fever, weight loss, and night sweats. In some cases, the paraneoplastic syndrome can be the first sign of the underlying malignancy. Here, we present a 47‐year‐old individual with angiosarcoma over the right scapula accompanied by hemoptysis and other pulmonary complaints whom at first was thought to be metastatic polmunary involvement. However, the patient's dramatic response to corticosteroids, in addition to further imaging and paraclinical studies, led us to an acute eosinophilic pneumonia (AEP) diagnosis which is an eosinophilic infiltrations of alveolar spaces. The patient received chemotherapy for angiosarcoma and radiation, since the brachial nerve network was disrupted, leaving the tumor unresectable. After 3 years of continuous follow‐up, the patient is now completely cured.

Background: late in 2019, the first case of COVID-19 was detected in China, and the disease caused pandemic state worldwide. Up to now, many studies investigated the impact of comorbid diseases, especially diabetes mellitus on COVID-19 outcomes. Objectives: In this study, we aimed to assess the para-clinic characteristics of COVID-19 patients with or without diabetes mellitus to identify factors indicative of poor prognoses. Methods: In this prospective study, 153 in-patients with COVID-19 were followed up from 1 March to 19 April. Paraclinical information of these patients was gathered from their medical records. Afterward, the association between these factors among both diabetic and non-diabetic patients were assessed in the correlation analyses. Results: discharge and expiration of 77.1% and 22.9% of the study participants resulted in a 1063 person-day follow up for patients who discharged healthily, and 384 person-day follow up for expired patients. 41.8% of the participants had diabetes mellitus. Lymphocytopenia and Neutrolhilia prevalences increased during hospitalization; comparing with their initial prevalences. Thirty-seven patients got acute respiratory distress syndrome; of those, 35 died. The mean of the initial C reactive protein level was 42.49 and serum creatinine of 1.39 Conclusion: The study showed that higher initial neutrophil count, increasing neutrophil count more than 15000 and decreasing lymphocyte count below 1000 during hospitalization; development of acute respiratory distress syndrome and being intubated; initial C reactive protein and serum creatinine level were associated with higher mortality rates in COVID-19 victims.

Abstract: Many aspects of Covid-19 infection, especially its complications and long-term health consequences are still unknown. Several reports concerning concomitant covid-19 infection and hematological disorders have been published recently. We aim to present a unique case of acute myeloid leukemia in a 61-year-old man with a previous history of covid-19 infection 40 days ago, with near complete resolution of signs and symptoms attributable to covid-19 infection. After 3 weeks, the patient presented again with progressive weakness, nausea, vomiting, and epigastric pain. No evidence of active covid-19 infection was observed. Instead, remarkable drop of hemoglobin and platelets relative to the values recorded in the discharge notes of the patient was observed. Further workup of the patient revealed evidence of acute leukemia and severe bone marrow involvement. We decided to present the current case as a concerning probable association.

Introduction: Determination of good diagnostic tools is an issue of importance specially to differentiate between sepsis etiologies and improvement of prognosis. Hence our purpose was to determine the finding of the peripheral blood smear (PBS) in patients with suspected of sepsis and its association with the final diagnosis in the year 1396. Methods: In this cross-sectional comparative survey, 348 consecutive patients with suspected of sepsis admitted in emergency department of Shohaday-e-Tajrish Hospital were enrolled and the association of finding of the peripheral blood smear in patients with the final diagnosis in the year 1396 were determined. Results: The results in this study demonstrated that pneumonia and urinary tract infection were seen in 29% and 18.1%. Thrombocytopenia (p=0.000), thrombocytosis (p=0.032), and abnormal morphology (p=0.049) were related to final diagnosis. Conclusion: Totally, according to the obtained results it may be concluded that platelet count and PBS morphology are important related factors for sepsis.

مقدمه: شناخت بهترین شیوه های تشخیص پاراکلینیک نقش مهمی در تشخیص افتراقی مبتلایان به سپسیس و بهبود پیش آگهی نهایی بیماران ایفا می نماید. لذا این مطالعه به منظور بررسی یافته های لام خون محیطی در بیماران مشکوک به سپسیس و ارتباط آن با تشخیص نهایی انجام شد. روش کار: در این مطالعه مشاهده ای که به صورت مقطعی انجام گردید، تعداد 348 بیمار مشکوک به سپسیس بستری در اورژانس بیمارستان شهدای تجریش در سال 1396 مورد ارزیابی قرار گرفتند و یافته های لام خون محیطی در آنها تعیین شده و ارتباط آن با تشخیص نهایی در بیماران بستری ارزیابی گردید. یافته ها: میانگین سنی بیماران مورد بررسی 3/62 سال با انحراف معیار 7/17 سال بود. همچنین 2/53 درصد از بیماران مورد بررسی مذکر و 8/46 درصد مونث بودند. شایعترین تشخیص های نهایی شامل پنومونی (29 درصد) و عفونت ادراری (1/18 درصد) بودند. در مورد یافته های لام خون محیطی ارتباط آماری معناداری با تشخیص نهایی بیماران در مورد یافته های ترومبوسیتوپنی (000/0 = p)، ترومبوسیتوز (032/0 = p)، مورفولوژی غیرطبیعی (049/0 = p) وجود داشت. نتیجه گیری: در مجموع چنین استنباط می شود که تعداد پلاکتها و مورفولوژی غیرطبیعی می توانند کارآیی تشخیصی خوبی در مورد بیماران مشکوک به سپسیس داشته باشند.