Ahmet Ifran

Platelet count, mean platelet volume, platelet distribution width, and plateletcrit do not correlate with optical platelet aggegation responses in healthy volunteers

BackgroundRecent advances in technology have made it possible to record various platelet indices. There have been many reports about platelet indices and platelet disorders. The aim of this study is to investigate whether anatomical indices have a correlation with functional aggregation responses using optical method in healthy adults and to evaluate the predictive significance of platelet indices over platelet aggregation responses.MethodsThis study was carried on 31 adults whose ages ranging between 20 and 42. Platelet parameters, including platelet count, mean platelet volume, platelet distribution width and plateletcrit were determined in platelet rich plasma using Abbott Cell-Dyn 4.000. Platelet aggregation was induced by adenosine diphosphate, collagen and epinephrine. Optical aggregation was performed using a turbidometric method.ResultsWe have observed no correlation between any of platelet indices measured and platelet aggregation responses.ConclusionsAs a result, we found no correlation between platelet aggregation responses obtained with optical method and platelet indices proposed as indicators of certain pathologic conditions, and it does not seem possible to use platelet indices as a direct indicator of platelet activation. In conditions where platelet functions should have been assessed, platelet indices alone are inappropriate and further evaluation is necessary with different methods.

Predictive value of discrimination indices in differential diagnosis of iron deficiency anemia and beta‐thalassemia trait

Objectives:  Iron deficiency anemia (IDA) and beta‐thalassemia trait (B‐TT) are the most common causes of hypochromic microcytic anemias. Many indices have been defined to quickly discriminate these similar entities via parameters obtained from automated blood count analyzers. The purpose of the study was to evaluate the predictive value of these indices in differential diagnosis of IDA and B‐TT in adult cases.

The effect of pre-eclampsia on complete blood count, platelet count and mean platelet volume

Pre-eclampsia is a condition observed during pregnancy and threatens the life of both mother and foetus. There are studies, which suggest platelets play a major role in the pathogenesis of pre-eclampsia. The aim of this study is to compare the complete blood count (CBC) parameters, especially platelet count and mean platelet volume (MPV), in pre-eclamptic and normal pregnant women and to evaluate whether these parameters have a prognostic significance in determining the severity of eclampsia. The study and control groups consist of 56 pre-eclamptic and 43 normal pregnant women, respectively. There was no statistically significant difference according to CBC, platelet count and MPV when pre-eclamptic and severely pre-eclamptic patients were compared with controls. As a result, we observed no prognostic significance of CBC, platelet count and MPV on the presence and/or severity of pre-eclamptic condition. There are conflicting results especially on the significance of MPV in the literature, and possibly this confliction is due to the difference between methods and/or equipments used for automated blood count.

Post-gastrectomy anemia: evaluation of 72 cases with post-gastrectomy anemia.

Abstract Anemia is common in patients following gastrectomy. The purpose of this study was to document causes of anemias developing during the post-gastrectomy period and to determine the importance of complete blood count parameters on types of anemia. A total of 72 patients (23 women and 49 men) who had previously undergone gastrectomy in the past and who were admitted for the evaluation of anemia were enrolled in study. The patients who were evaluated and treated for anemia in the post-gastrectomy period were excluded. Iron deficiency anemia was present in 68 (94.4%) of72 gastrectomized patients with anemia. Deficiencies of vitamin B12 and folate were present in 57 (79.2%) and in three patients, respectively. The most common cause of anemia was the combination of iron and vitamin B12 deficiencies. Iron deficiency was present in the majority of patients, followed by vitamin B12 deficiency in frequency. In all combinations of iron deficiency, the values of mean cell hemoglobin and mean cell hemoglobin concentration were either normal or low. In cases who had low white blood cell and platelet counts vitamin B12 deficiency was frequent, while in cases who had high numbers of white cells or platelets iron deficiency was more frequent. In conclusion, gastrectomized patients should be followed for anemia and treated appropriately based on the cause of anemia.

Platelet-derived microparticle levels in women with recurrent spontaneous abortion

To investigate the significance of platelet‐derived microparticles (PMPs) in women with recurrent spontaneous abortion.

Thrombophilia-associated gene mutations in women with pregnancies complicated by fetal neural tube defects

Neural tube defects (NTDs) are one of the most common fetal defects. The causes of these defects are considered to have multiple factors involving nutritional deficiencies, genetic predisposition, and environmental factors such as drug exposure [1]. The aim of our study was to investigate the frequencies of thrombophilia-associated gene factor V Leiden mutations and prothrombin gene G20210A mutations, as well as methylenetetrahydrofolate reductase MTHFR C677T mutation which has a substantial role in the folate mechanism of women experiencing pregnancies with NTDs. This study consisted of 2 groups: group 1 consisted of 29 women whose previous pregnancies were complicated with NTDs, and group 2 was the control group consisting of 35 women who experienced uncomplicated pregnancies. The ages of patients in the control group matched with those in the NTD group. Case characteristics are displayed in Table 1. The frequency of theMTHFRC677Tmutationwas found to be significantly higher in women who experienced pregnancies withNTDs,while occurrence of factor V Leiden andprothrombin gene G20210A mutations were not significantly different between the study and control groups. The frequency of both homozygous and heterozygous MTHFR C677T mutation was 69.0% inwomenwho experienced pregnancies with NTDs (42.9% in the control group). Thepresence ofMTHFRC677Thad an odds ratio of 2.96 (95.0%CI, 1.05–8.32) for the development of NTDs. The frequencies of factor V Leiden, prothrombin geneG20210A, and MTHFR C677T mutations and allele frequencies with statistical comparisons are shown in Table 1. A study by Akar et al. [2] showed no relationship between MTHFR C677T mutation and spina bifida. However, they suggested that coexpression of MTHFR A1298C and MTHFR C677T mutations increased the risk of spina bifida. A similar association for NTD cases was reported in another study [3]. ⁎ Corresponding author. Department of Obstetrics and Gynecology, Gulhane Military Medical Academy, Etlik, 06010 Ankara, Turkey. Tel.: +90 312 3045818; fax: +90 312 3045800. E-mail address: temelceyhan@yahoo.com (S.T. Ceyhan).

Recombinant human granulocyte colony-stimulating factor (rhG-CSF) promotes in vitro platelet aggregation

Abstract rhG-CSF is increasingly used for stimulation of granulopoiesis and stem cell mobilization in healthy donors for allogeneic stem cell transplantation. However, a possible association between thrombosis and rhG-CSF administration has been reported. For that reason, in this study, we investigated the effect of rhG-CSF on platelet aggregation in whole blood of 10 healthy volunteers. Three concentrations of rhG-CSF solution (1, 10 and 100 ng/ml) were prepared. Each concentration of rhG-CSF solution and a control diluent without rhG-CSF were incubated with whole blood. Incubation with rhG-CSF solutions would result in 0.1, 1.0 and 10 ng/ml rhG-CSF concentrations in the blood. After incubation, aggregation responses were evaluated with ADP (5 and 10 μM) and collagen (2 and 5 μg/ml) in whole blood. When compared to control, preincubation with all dilutions of rhG-CSF augmented aggregation of platelets induced by ADP and collagen in a statistically significant manner (p < 0.05 for all comparisons). There was also a relationship between rhG-CSF concentration (1, 10 and 100 ng/ml) and augmentation of platelet aggregation response (p < 0.0001 for 5–10 μM ADP; p < 0.0001 for 2–5 μg/ml collagen). In conclusion, this study with an in vitro model showed that rhG-CSF administration may lead to platelet hyperaggregability.

Multiple myeloma presenting with acquired factor VIII inhibitor

An initial presentation of hematological malignancies associated with autoantibodies is not common, and there is only one documented case of multiple myeloma presenting with acquired FVIII inhibitor for multiple myeloma. In this paper, we describe a second case of multiple myeloma who presented with acquired FVIII inhibitor. A 43-year-old woman was referred to our hematology unit for anemia and an elevated erythrocyte sedimentation rate. Two months before her admission, she had undergone an operation at a local hospital because of ovarian cyst rupture complicated by severe postoperative bleeding. Because coagulation tests had revealed a prolonged partial thromboplastin time which could not be corrected by a mixing test and a decreased FVIII level, a diagnosis of acquired FVIII inhibitor had been made. The patient was hospitalized in our unit for further evaluation. The erythrocyte sedimentation rate was 110 mm/h, serum albumin level 2.5 g/dL, globulin level 5.6 g/dL, and C-reactive protein 47.8 mg/L (0–6). Serum IgG was high, and serum protein electrophoresis showed a monoclonal spike in the gamma region. An IgG-kappa paraprotein was identified by immunofixation of the urine and serum. X-ray films of the bones revealed lytic areas in the skull, pelvis, and lumbar vertebrae. Bone marrow aspiration showed normal cellularity with 40% plasma cell infiltration. The patient was diagnosed with the IgG kappa type of multiple myeloma associated with acquired FVIII inhibitor. In patients presenting with severe bleeding, autoantibodies against FVIII should be considered for the differential diagnosis of bleeding. Clinicians should be alert to the presence of rare underlying neoplastic diseases such as multiple myeloma, in patients with acquired FVIII inhibitor.

Efficacy of caspofungin in prophylaxis and treatment of an adult leukemic patient with invasive pulmonary aspergillosis in allogeneic stem cell transplantation

Invasive aspergillosis is a major problem in the management of immunocompromised patients, its prevalence is rising and it is still a major cause of death in this group. The clinical success rate with classical drugs is far away from expectations. New drugs are needed in the treatment of this complication. Belonging to the new class of echinocandins, caspofungin is a newly introduced and promising drug in this fatal situation. We report a patient with acute myeloid leukemia who had invasive pulmonary aspergillosis during induction therapy being treated with amphotericin B in first step and afterwards with caspofungin. The patient received consolidation therapy and allogeneic stem cell transplantation while using caspofungin, and did not experience any adverse effect related to drug. Many side effects, e.g. derangements in liver and kidney functions, hypokalemia, infusion‐related side effects and especially thrombocytopenia, which are common with amphotericin B treatment are no longer problem with caspofungin. The efficacy of caspofungin in terms of regression of pulmonary lesions and control of fever is quite successful. The optimal therapies for opportunistic fungal infections are still debated, and further evaluation is needed.

Discrimination indices as screening tests for beta-thalassemia trait

Dear Editor,We have read with great interest the study by Ntaios et al.[1], which was published online in your journal. The reasonfor our interest is the recent publication of our studyevaluating the predictive value of discrimination indicesused in patients with iron deficiency anaemia (IDA) andbeta-thalassemia trait (B-TT) [2]. In this paper, we thinkthat evaluating the results of both studies as a whole is veryimportant in understanding the predictive value of thesediscrimination indices used in differential diagnosis of suchpatients. Besides Mentzer index (MI), Green and Kingindex (G&K), RDW index (RDWI), England and Fraserindex (E&F), red cell distribution width (RDW), and redblood cell (RBC) count evaluated in their study, we haveadditionally evaluated Shine and Lal index, Srivastataindex, and Ricerca index in our study, and we have foundthat these indices, similar to others, also do not have enoughpredictive value in discriminating these two entities. An-other difference between two studies is the exclusion ofIDA cases with hemoglobin (Hb) value <8.7 g/dl in ourstudy. Hb values of patients with B-TTusually range from 9to 11 g/dl [3]. Demir et al. [4] had excluded IDA cases withHb value <8.7 g/dl in their study performed in paediatricpopulation, because these cases are not confused with B-TTcases in practice. Our study was performed to establish thestatus in adult cases with inspiration from the results of thisstudy [2]. If such an exclusion has not been done, it isobvious that IDA cases with much lower Hb and hematocritvalues than B-TT cases would be included in studypopulation, and in this case, statistical homogeneity ofcompared populations would deteriorate. As a result, therewould be unexpected deviations in indices such as E&F inwhich Hb and hematocrit values play a substantial role.Evaluation of the results of the study published in yourjournal with exclusion of IDA cases having Hb value<8.7 g/dl could give rise to different results. A superiorityof the study by Ntaios et al. [1] is the inclusion of largernumber of cases compared to our study (while we have 45IDA and 66 B-TT cases in our study, they have included120 IDA and 373 B-TT cases in their study). G&K wasfound to have the highest reliability in their study, whilethis index had the second highest predictive value afterRBC count in our study (according to Youden’s index70.86 and 65.5, respectively). Investigators found thatRDW was extremely insufficient in discriminating caseswith IDA and B-TT, and this finding is similar in bothstudies (according to Youden’s index