E-ISSN: 1308-5263
Turk J Hematol: 17 (3)
Volume: 17  Issue: 3 - 2000
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1.Immunosuppressive Therapy-Induced Hepatotoxicity in Patients with Aplastic Anemia
İmdat Dilek, Ramazan İdilman, Semin Fenkçi, Celalettin Üstün, Haluk Koç, Osman İlhan, Hamdi Akan
Pages 111 - 117
Immunosuppressive therapy is a treatment for aplastic anemia patients who are not candidates for hematopoietic stem cell transplantation. The aim of the study to evaluate the frequency and severity of immunosuppressive therapy-induced hepatotoxicity in patients with aplastic anemia. The records of 27 patients with aplastic anemia who had eceived immunosuppressive therapy were received and determined for evidence of hepatotoxicity. The patients were divided into three groups. Group 1 was treated with antithymocyte/antilymphocyte globulin and cyclosporin A, group 2 received onl yyclosporin-A and group 3 was treated with antithymocyte/antilymphocyte globulin + cyclosporin-A and granulocyte macrophage colony-stimulating factor. All patients in group 1 had an initial increase in AST and ALT levels after therapy, but these tests abnormalities returned to normal in each case (p> 0.05). There was no detectable change in AST and ALT levels in group 2 (p>0.05). In group 3, five patients had an increase in ALT and AST levels in the initial several days after therapy was started but he levels gradually returnedto normal by the second or third week of therapy.

2.Natural Inhibitors and Lipids in Patients with Sickle Cell Disease
Duran Canatan, Nurgül Oğuz, Ahmet Özsancak, İbrahim Aslan, Aynur Bengü, Alim Gürman, Bekir Sarıca
Pages 119 - 122
Microvascular occlusion in sickle cell disease (SCD) is a multifactorial process. Disordered coagulation may play a role in the pathogenesis of vaso occlusive crisis (VOC). The aim of this study was to evaluate the patients and to investigate their Protein C (PC), Protein S (PS) and AT-III levels during normal and crisis periods. A total of 18 patients with SCD were included in this study at the Antalya State Hospital, Thalassemia Center. The mean number of VOC episodes of the patients per year was 4.1 – 3.2. Complications in patients included 4 cases of osteonecrosis (23.5%), 2 cases of holealithiasis (11.7%), 2 cases of leg ulcers (11.7%), and 3 splenectomies (17.6%). The patients during noncrisis periods have lower cholesterol and higher triglycerides levels than the controls (p< 0.001). Hepatic and renal functions were normal in all patients. The mean totals of the PS, PC and AT-III levels were statistically lower both in non crisis and in crisis periods than the control (p< 0.001), but there was no statistical difference between the levels durining noncrisis and crisis periods. In conclusion, PC, PS and AT-IIII deficiencies in patients with SCD are certain. However, these deficiencies do not change during noncrisis and crisis situations and does not play a role on the period of crisis. Abnormal lipid patterns may be a predisposing condition for a crisis.

3.Hematological Values of Healthy Adult Population Living at Moderate Altitude (1869 m, Erzurum, Turkey)
Hasan Kaya, İlhami Kiki, Ersin Akarsu, Mehmet Gündoğdu, S. Başol Tekin, Tacettin İnandı
Pages 123 - 128
In this study, the normal hematological values in healthy adults living in Erzurum area in Turkey at moderate altitude (1869 m above sea level), and the effect of moderate altitude on these hematological values was investigated. The study population comprised of 929 females and 1204 males aged between 17-95. The mean values for red blood cell and leukocyte counts, and hemoglobin level were significantly higher in males than in females (p<0.0001), whereas platelet count was significantly higher in females than in males (p<0.0001). ›n conclusion, we could not find an increase in the number of red blood cells as well as other hematological parameters in healthy adults living in Erzurum area. Hematological values in this study were similar to those reported in the previous studies carried out with those living under 1869 m.

4.Ticlopidine Induced Anemia and Agranulocytosis
Ali Keskin, Yurdaer Sermez
Pages 129 - 132
A 63-year-old man with a history of transient ischemic attack had been treated with ticlopidine for 2 months. He presented with a 6-day history of fever, sore throat, and generalized weakness. Agranulocytosis and anemia due to ticlopidine was diagnosed, and the ticlopidine was discontinued. Broad-spectrum antibiotics and granulocyte colony stimulating factor were administered. The recovery of the granulocyte count and an improvement of the clinical condition were noted on the 6th day of the admission.

5.Multiple Cerebral Emboli in a Homozygous b-Thalassaemia Patient Due to Factor V 1299 (His-Arg) 4070 A-G Mutation
Nejat Akar, Sabri Kemahlı, Gülhis Deda, Ece Akar, Erkan Yılmaz, Zümrüt Uysal, Şükrü Cin
Pages 133 - 136
Thromboembolic episodes are quite rare in beta thalassemia major patients although there is a tendency for thrombosis in haemolytic anaemias. We report a patient with cerebral thromboembolic episode triggered by a minor blood group incompatibility in which the underlying defect of factor V 1299 (His-Arg) was detected three years after his death.

6.Could Parvovirus B19 Induce a Rejection After Bone Marrow Transplantation in a Patient with Diamond-Blackfan Anemia?
Nazan Sarper, Nevin Yalman, Sema Anak, Hülya Bilgen, Semra Özgenç, Emine Can, Gündüz Gedikoğlu
Pages 137 - 141
A four year-old-girl with Diamond-Blackfan anemia (DBA) that was resistant to corticosteroid treatment and transfusion dependent underwent (bone marrow transplantation) BMT from HLA identical sibling. The patient was conditioned with busulfan and cyclophosphamide and achieved complete marrow engraftment and mixed chimerism in DNA analysis. For the following 13 months she was not transfusion dependent and had a 100% Karnofsky score. But on the 14th month she had anemia ollowing fever, rash and enteritis. Parvovirus B19 IgM seropositivity confirmed Parvovirus infection. Although intravenous immunoglobulin was administered, bone marrow morphology and DNA analysis revealed rejection. Although mixed chimerism detected shortly after the BMT procedure might raise the possibility of an ongoing slow graft rejection during the relatively stable remission period, we think that parvovirus B19 had also contributed rejection.

7.Images in Haematology
Melih Aktan, Günçağ Dınçol
Page 143
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