Pediatric traumas and critical illnesses are known to confer increased risk for hospital-acquired venous thromboembolism (HA-VTE) in children. The development of HA-VTE in children is associated with increased mortality and disabling co-morbidities. In this narrative review, we discuss the current literature on HA-VTE in children with severe trauma and those who are critically ill. The pediatric literature in this field continues to grow with randomized trials and guidelines actively being developed. We describe the available data related to the frequency of HA-VTE specific to these populations, as well as the pathophysiological concepts and considerations for its development and management. We outline an approach to HA-VTE in these two groups by delving into risk assessment and the identification of risk factors that accrue in these children, the need to assess for thromboprophylaxis and balance its risks and benefits, the clinical presentation and imaging modalities to confirm the diagnosis of HAVTE, and management principles for developed HA-VTE. We use some of the currently available guidelines, including those of the Eastern Association for the Surgery of Trauma and Pediatric Trauma Society and the recently updated 2024 American Society of Hematology/ International Society on Thrombosis and Haemostasis guidelines on the management of VTE in children, to aid in our discussion.

Objective: Patients with large B-cell lymphoma (LBCL) who are relapsed/refractory (R/R) after frontline therapy have traditionally experienced highly unfavorable outcomes. The development of T-cell redirecting therapies is rapidly changing that outlook, but costs and infrastructural challenges limit access to these innovative therapies. This study was conducted to document the shortcomings of management in the absence of regular access to T-cell redirecting therapies in a contemporary patient population and define the subgroups with the most urgent need for accessing innovative treatments.
Materials and Methods: The second-line management strategies and outcomes of a large real-world LBCL cohort from Türkiye were retrospectively analyzed with the participation of 9 centers from 4 different geographical regions.
Results: Despite the contemporary nature of the treatment strategies (2012-2024), there was no regular access to novel agents. The median progression-free survival after the first progression (PFS- 2) was 6.9 months. Fewer than one-fourth of all patients (24.3%) received transplantation following a response to second-line therapy, constituting the only subgroup to benefit from standard care (2-year PFS-2: 67.8%). The remaining 295 patients (75.7% of the cohort) had median survival of 6.1 months and 2-year PFS-2 of 10.3%. Progression within a year from diagnosis, non-curative intent at the second line of therapy, and failure of curative second-line therapy were key adverse features for a dismal prognosis, with median survival durations of 8.8, 2, and 7.4 months, respectively.
Conclusion: The current therapeutic strategy of intensive chemoimmunotherapy followed by autologous transplantation yields a reasonable chance of survival for only one-fifth of patients. The findings of this study emphasize the urgent need for expanding access to T-cell redirecting approaches in R/R LBCL for early progressors, transplant-ineligible cases, and patients who fail intensive secondline regimens.

Objective: Thrombotic microangiopathy (TMA) is a serious condition characterized by microangiopathic hemolytic anemia and thrombocytopenia, with high exacerbation rates. This study examined all-cause and exacerbation-related readmission risks among patients hospitalized with TMA requiring plasmapheresis.
Materials and Methods: Secondary analysis of the 2020 Nationwide Readmission Database was conducted, including discharge data from non-federal hospitals in 31 U.S. states. Patients aged 18 years or older admitted non-electively with a primary or secondary diagnosis of TMA requiring plasmapheresis were included. Exacerbationrelated readmission was defined as subsequent admission requiring plasmapheresis within 7 or 30 days after the original discharge. Multivariable logistic regression and Cox proportional hazards models were used to assess readmission risks, adjusting for demographics, comorbidities, and predisposing factors.
Results: Among an estimated 1393 patients, 791 (56.8%) had predisposing conditions. All-cause readmissions were more frequent in patients with predisposing conditions (26.2% vs. 21.9%), while exacerbation-related readmissions were more common in TMA-only patients (9.0% vs. 3.4% at 7 days; 13.7% vs. 6.4% at 30 days). Most exacerbations occurred within 14 days after discharge. No patients treated with caplacizumab experienced exacerbation. TMA-only patients had a 2.1-times higher risk of 30-day exacerbation-related readmissions (adjusted hazard ratio: 2.10, p=0.04). Rural residence and patient-directed discharge were potential risk factors for exacerbation-related readmissions.
Conclusions: These findings highlight the need for improved postdischarge care and treatment strategies to prevent readmissions. Further studies should explore interventions to reduce exacerbationrelated readmissions, particularly in high-risk populations.

Objective: Primary immune thrombocytopenia (pITP) is an acquired bleeding disorder involving decreased numbers of platelets due to platelet destruction or impaired production. The clinical presentation of pITP can be multifaceted and thrombotic events may rarely manifest. Thrombosis can develop with treatment or during the untreated period. The primary objective of this study was to examine the frequency of arterial thromboembolic events (ATEs) in patients with pITP. We also aimed to evaluate the risk factors in these patients and the effect of ITP treatments on ATEs.
Materials and Methods: The study was designed as a retrospective multicenter study conducted under the guidance of the Turkish Society of Hematology’s Scientific Subcommittee on Hemostasis- Thrombosis. Patients over the age of 18 with pITP who subsequently developed ATE while undergoing follow-up for pITP were evaluated.
Results: A total of 2,178 patients with pITP were screened and 37 patients (1.7%) were observed to have developed ATE. The mean age was 62 years. Fifteen (40.5%) of the patients who developed ATEs were not receiving pITP treatment at the time of thromboembolism. Among the patients receiving pITP treatment at the time of the ATE, 9 (24.3%) were receiving eltrombopag and 10 (27%) were receiving corticosteroids. Compared to patients who did not develop ATEs, multivariate analysis revealed that the presence of hypertension, comorbidity, and history of venous thromboembolism statistically significantly increased the risk of developing ATEs (p=0.008, p=0.018, and p=0.038, respectively).
Conclusion: The risk of ATEs may increase in pITP patients both during and without treatment. It is important to inquire thoroughly about the presence of comorbidities, atherosclerotic risk factors, hypertension, and history of thrombosis in these patients at the initiation of treatment. Correctable risk factors should be addressed to minimize the number of risk factors present. The treatment of pITP must be individualized, including consideration of age-related disorders.

Objective: Hemophilia A (HA) is an X-linked hereditary bleeding disorder caused by variants in the coagulation factor VIII (F8) gene, with a current estimated prevalence of 17.1 per 100,000 male individuals. This study aimed to establish a gene variant spectrum in China using long-distance polymerase chain reaction (PCR) and nextgeneration sequencing.
Materials and Methods: Long-distance PCR was used to detect intron inversions and next-generation sequencing gene panels were used to identify small sequence variants.
Results: Fifty-two different F8 variants were identified in 78 patients from unrelated families, including single-nucleotide alterations (missense, nonsense), frameshifts (small deletions/insertions), splicingsite changes, complex variations, and large rearrangements (inv22 or inv1). The nine variants reported here for the first time include two missense variants, two nonsense variants, four frameshifts, and one splicing alteration.
Conclusion: The F8 gene mutation spectrum of patients with HA from Guangxi Province was established and genotype-phenotype correlations were explored. This study contributes data to the existing F8 mutation database and helps systematically identify the mutation spectrum of the gene for HA in southern China.

Objective: Regular erythrocyte suspension transfusions are still performed for most patients with beta-thalassemia major to prevent anemia. In recent years, it has been observed that patients are exposed to multiple allogeneic antigens and this leads to changes in the immune system. Understanding the immune regulators responsible for alloantibody development in thalassemia patients will provide appropriate data for the reduction and/or prevention of alloimmunization. We aimed to evaluate the association of alloimmunization and immune functions in these patients.
Materials and Methods: Fifty-four patients with thalassemia between the ages of 1 and 24 years were retrospectively analyzed. The frequency and types of alloantibodies and the immune functions and demographic characteristics that affected their formation were examined in these patients.
Results: The rate of alloantibody detection was 29.6%. There was a median interval of 13.7 years from the start of transfusions to alloantibody development. The age at initiation of regular transfusions was significantly higher in patients with alloantibody development. We found strong relationships between alloantibody development and both direct Coombs positivity and low C4+ and low CD19+ B-cell numbers. However, no significant difference was found between the groups in terms of serum immunoglobulin (Ig) G, IgA, IgM, and C3 levels; total lymphocyte count; or CD3+, CD4+, CD8+, and natural killer cell counts.
Conclusion: Studies at the molecular level should be increased and research should be conducted with larger numbers of patients to clarify the immune pathogenesis of alloimmunization and determine the markers that will enable early recognition.

Acquired hemophilia A (AHA) is a rare but potentially life-threatening bleeding disorder. This single-center retrospective study aimed to assess clinical features, treatment strategies, and prognostic indicators in adult AHA patients. Eleven patients diagnosed between 2008 and 2024 were reviewed. Clinical data, laboratory findings, treatments, and outcomes were analyzed. Survival estimates and prognostic factors were evaluated using Kaplan-Meier and univariate analyses. Median age was 41 years; 54.5% of the patients were female. Pregnancy-associated AHA (36.4%) had excellent outcomes with steroid monotherapy and no relapse. Idiopathic and autoimmune cases required combination therapy and had higher relapse rates. The median follow-up duration was 27 months. All patients achieved remission (median response time: 62 days), though 36.4% relapsed. High inhibitor titer (>20 Bethesda unit) predicted delayed response (p=0.038); male sex and major bleeding were linked to shorter relapse-free survival. Baseline inhibitor burden and disease etiology influence AHA prognosis. Tailored therapy and multicenter validation are warranted to refine management strategies.