E-ISSN: 1308-5263
Turkish Journal of Hematology - Turk J Hematol: 22 (2)
Volume: 22  Issue: 2 - 2005
EDITORIAL
1. Dear members of Turkish Society of Haematology
Aytemiz Gürgey
Page 57
Abstract |Full Text PDF

REVIEW
2. Thrombocytosis in solid tumors: review of the literature
Çağatay Arslan, Hasan Şenol Coşkun
Pages 59 - 64
Abstract |Full Text PDF

RESEARCH ARTICLE
3. Failure of puberty and linear growth in beta-thalassemia major
Hamdollah Karamifar, Mehdi Shahriari, Gholam Hossein Amirhakimi
Pages 65 - 69
Thalassemia major is a severe progressive hemolytic anemia and a serious medical problem worldwide. Endocrine dysfunctions are well described in patients with thalassemia major. Data for endocrine complications from developing countries are scant. Endocrine complications in developing countries may be frequent due to suboptimal iron chelation. The aim of this study was to evaluate the prevalence of delayed puberty and growth failure in patients with beta-thalassemia major. We evaluated the growth and sexual development of 146 patients with thalassemia major aged 10-22 years. The following data were recorded in questionnaire, age, sex, height, weight, serum ferritin levels and pubertal staging. Failure of puberty was present in 75.6% of boys and 68.4% of girls aged 12-22 years. Gonadotropin insufficiency was found in most of the patients with lack of puberty. There was a significant difference between the height of patients with pubertal development (153 ± 9.1 cm) and those with delayed puberty (140 ± 9.1), (p< 0.001). Short stature was present in 65.7% of patients. Sixty-nine percent of boys and 62.9% of girls were found to be less than 2 SD below the mean for normal height; after the age of 12, the percentage was 78.9% in girls and 83.8% in boys after the age of 14. We conclude that failure of puberty and impaired growth are very common in our thalassemic patients which necessitates newer protocols of treatment, correct blood transfusion and chelation therapy.

4. Evaluation of inherited and acquired platelet function disorders in iron deficient women with menorrhagia by whole blood lumi-aggregometer
O. Meltem Akay, Fezan Şahin, Zafer Gülbaş
Pages 71 - 78
The commonest cause of iron deficiency anemia (IDA) in premenopausal women is often menstrual blood loss. However, no organic pathology is identified in more than 50% of menorrhagic women. We therefore investigated inherited and acquired bleeding disorders among women with unexplained menorrhagia who developed IDA. In vitro whole blood platelet aggregation (PA) with ADP, arachidonic acid (AA), ristocetin and collagen was studied in addition to full blood count, serum iron levels, serum iron binding capacity, transferrin saturation, ferritin, prothrombin and activated partial thromboplastin time, fibrinogen, D-Dimer, Factor VIII, Factor IX, Factor XI, ristocetin cofactor activity, blood type and bleeding time in 67 women before and after therapy. Before therapy; decreased agonist induced PA was observed in 20% of women by ADP, in 12% by AA, in 2% by ristocetin and in 6% by collagen. After oral iron therapy, decreased platelet aggregation was shown in 8% of women with ADP and 2% of women with AA while initial abnormal ristocetin and collagen induced platelet aggregation responses became normal. Also there was a statistically significant increase of ristocetin cofactor activities and FXI levels after iron repletion. We conclude that; rather than von Willebrand disease, platelet function abnormalities and FXI deficiency are the most common hemostatic disorders in women with unexplained menorrhagia and significant portion of these disorders can be reversed by iron therapy.

5. Allogeneic stem cell transplantation in chronic myeloid leukemia two and a half year experience
Khalil Ullah, Badshah Khan, Parvez Ahmed, Iftikhar Hussaın, Shahid Raza, Muhammad Naeem, Hamid Iqbal, Hamid Saeed, Khalid Kamal
Pages 79 - 86
This study is performed to evaluate outcome of allogeneic stem cell transplantation (SCT) in chronic myeloid leukemia at Armed Forces Bone Marrow Transplant Centre, Rawalpindi from Apr 2002 to Oct 2004. Twenty-two patients with CML underwent allogeneic SCT from HLA matched siblings. Patients were divided into standard (n= 14) and high-risk (n= 8) groups. Patients were subjected to conditioning regimens consisting of busulphan and cyclophosphamide. Cyclosporin, prednisolone and methotrexate were given for GVHD prophylaxis. All donors were subjected to PBSC harvest after G-CSF therapy for five days. All patients received G-CSF from day + 5 until ANC > 0.5 x 109/L. The median age of the patients was 29 years (range 7-53 years) with a male to female ratio of 6.3: 1. Engraftment was achieved in all patients. Median time to achieve neutrophil (ANC 0.5 x 109/L) and platelet (20 x 109/L) recovery was 13 days and 12 days respectively. Median stay in hospital was 18 days. Acute GVHD (Grade II-IV) was observed in eleven patients (50%) while chronic GVHD was seen in four patients (18%). One patient relapsed 8 months post-transplant. Two patients (9%) developed VOD liver. One patient had haemorrhagic cystitis. Four patients (18%) developed post-transplant infectious complications, which included Pseudomonas septicemia, aspergillosis, tuberculous pleural effusion and herpes zoster. Overall mortality was 22.7% (n= 5). The major causes of mortality were VOD liver, GVHD grade IV, Pseudomonas septicemia and aspergillosis. Overall survival was 77.2% (n= 17) and disease free survival was (n= 16) 72.7%. Follow up ranges from 23 to 828 days (median 212 days). The preliminary results of SCT in this small series of patients with CML are very encouraging. To improve the long-term survival it is imperative that patients are transplanted early after diagnosis and conditioning regimens are selected carefully.

6. The effect of a nationwide antibiotic restriction policy on antibiotic usage in a stem cell transplantation unit
Alpay Azap, Pervin Topçuoğlu, Ayşegül Yeşilkaya, Mutlu Arat, Osman Memikoğlu, Özay Akan, Halil Kurt, Emin Tekeli, Hamdi Akan
Pages 87 - 90
The Turkish Ministry of Health has released a regulation in February 2003 in order to decrease, first the antibiotic expenses and second, inappropriate use of antimicrobial agents. The aim of this study is to assess the impact of this nationwide antibiotic restriction (NAR) in the most active stem cell transplantation unit (SCTU) in Turkey. All patients followed up in SCTU and had received antimicrobial therapy in the period of four months before and after NAR were evaluated retrospectively. The appropriateness of antimicrobial treatments was assessed by two ID specialists and one ID professor. Disagreements between investigators were solved by discussion and review of published guidelines. There were 10 and 25 patients who were on antimicrobial therapy in the 1st (before NAR) and 2nd (after NAR) group, respectively. Seventeen of the patients had undergone allogeneic stem cell transplantation, while 6 were allogeneic bone marrow recipients and 12 were autologous peripheral stem cell recipients. The antibiotic days per patient was 33.4 and 19.4 in the first and second groups respectively (p=0.036). Although it was not significant, the appropriateness of antibiotic regimens used in the second group was higher than the first group (OR: 5, CI: 0.9-26.4, p= 0.059). The significantly lower antibiotic day per patient in the 2nd group may be the result of collaboration between infectious diseases and hematology physicians settled after NAR in our hospital. NAR had reduced the antimicrobial use in our unit mainly by providing collaboration between infectious diseases and hematology departments.

CASE REPORT
7. A rare syndrome that can easily be missed: May-Hegglin anomaly
İsmet Aydoğdu, Emin Kaya, İrfan Kuku, M. Ali Erkurt, Ahmet Görgel, Onur Özhan
Pages 91 - 93
May-Hegglin is a rare disease characterized by macrothrombocytopenia and presence of Döhle-like bodies in white cells. We present a patient treated with acute myeloid leukemia had pale-blue colored inclusion bodies assuming Döhle in his neutrophils.

8. Development of autoimmune hemolytic anemia during the treatment of a patient with acute myelomonocytic leukemia
Pınar Tarkun, Abdullah Hacıhanefioğlu, Emine Demirbağ, Tuğba Turgut
Pages 95 - 99
Drug induced autoimmune hemolytic anemia is a well-known complication of drug therapy but it is often misdiagnosed. Drug induced autoimmune hemolytic anemia is difficult to differantiate from classical autoimmune hemolytic anemia. Here, we have reported a case with autoimmune hemolytic anemia might be caused by drugs such as teicoplanin, imipenem and amphotericin B. In our case, on the fifteenth postadmission day was occur autoimmune hemolytic anemia. At this while, chemotherapy of patient had been completed and the patient have been taking antibiotherapy which include teicoplanin, imipenem and amphotericin B. Antibiotherapy could not be stopped because of febrile neutropenia. Symptoms and sings of anemia improved with prednisolon therapy. Suspicious drug must be stopped in drug induced autoimmune hemolytic anemia but in the conditions that drug could not be stopped, steroid treatment can be used in the treatment of hemolytic anemia.

IMAGES IN HEMATOLOGY
9. Images in Hematology
Turgay Fen, Başak Gören
Page 101
Abstract |Full Text PDF