Ilgen Sasmaz

NON-HODGKIN LYMPHOMA PRESENTING WITH UVEITIS OCCURRING AFTER BLUNT TRAUMA

We report here an unusual patient suffering from visual loss with refractory uveitis which was occured after a blunt trauma to her left eye. While in the hospital cervical lymph node and anterior chamber aspiration cytology with immunohistochemical staining were performed. The histopathologic diagnosis was highly malignant B-cell non-Hodgkin lymphoma. After the inflammation of the eye was regressed with chemotherapy, pars plana vitrectomy-lensectomy was performed. She was free of inflammation and the best corrected visual acuity was increased. However, she had a refractory inflammatory episode with clumps of cells in the anterior chamber 10 months after the operation. Local radiotherapy to the left eye was applied. Radiotherapy provided local control and preservation of the vision. The present case is presented in order to emphasize the importance of systemic evaluation in uveitis and possible role of trauma leading migration of atypical cells into the eye.

Management of Life-Threatening Hemorrhages and Unsafe Interventions in Nonhemophiliac Children by Recombinant Factor VIIa

The literature on the use of recombinant factor VIIa (rFVIIa), which was initially used in hemophiliac patients with inhibitors, for hemorrhages that cannot be managed with conventional methods or operations that cannot be performed safely is increasingly growing. This study presents a group of nonhemophiliac patients with hemorrhagic problems or hemorrhage risk for some interventions that were successfully resolved with the use of rFVIIa. The patient group was composed of 20 patients with different disorders resulting in similar results as hemorrhage or hemorrhage risk. Most of the patients were diagnosed with liver disorders primary or secondary to other diseases. The remaining cases were patients with leukemia, sepsis, intracranial hemorrhage, and burn. Some of the patients had multiple problems like a patient with liver disorder and intracranial hemorrhage or a leukemia patient with sepsis and disseminated intravascular coagulation. rFVIIa had been administered to the patients at dosages between 70 and 150 μg/kg up to 6 doses with 2-hour to 3-hour intervals. All the patients had benefited from the use of rFVIIa even though some of them died because of primary disease. This study shows that rFVIIa can be safely used in high-risk patients with a history of recurrent hemorrhage, for whom no improvement can be achieved in the hemostasis tests.

A successful use of recombinant factor VIIa in a patient with inhibitors, for bilateral cataract operation and circumcision.

The most common and serious complication of using factor preparations for haemophilia patients is development of inhibitors against factor VIII (FVIII) and factor IX (FIX). As the existence of inhibitors lead to ineffective replacement therapy via inhibiting the biological activity of the factor infusions; bleedings that are clinically unresponsive to treatment may be seen. The level of the inhibitors, measured quantitatively in Bethesda units, may generally be diminished when no factor replacement was performed; however, soon after a factor is replaced, the level of the inhibitors might again be increased to high levels because of the anamnestic response. There are mainly two approaches for treating the bleedings in haemophilia patients with inhibitors. First approach is to induce immune tolerance with high doses and long-term use. The duration of the therapy may change between a few months and years [1,2]. When bleeding occurs in a patient with inhibitors, the repeated use of factors is possible and effective with this approach. However, this therapy approach carries the disadvantage of having a low success rate and a high cost. The second therapy approach at the bleedings and surgical procedures for the haemophilia patients with inhibitors is the successful use of prothrombin complex concentrates [1], active prothrombin complex concentrates (APCC, FEIBA [Baxter Healthcare, Glekdale, CA, USA]) and the recently introduced recombinant factor VIIa (rFVIIa, NovoSeven, Novo Nordisk A/S, Denmark) [1]. In this case report, the successful use of rFVIIa during the bilateral cataract operation and concurrent circumcision performed on haemophilia A patient with inhibitors is presented and discussed within the scope of the available literature.

Eltrombopag For Immune Thrombocytopenic Children in a Single Region

Objective Child patients of chronic thrombocytopenic purpura with severe and resistant thrombocytopenia were evaluated to observe whether their clinical or laboratory states improve by one of the thrombomimetic therapeutic agent called Eltrombopag as in adults in a single center of different country from previous studies. Materials and Methods Nineteen patients with chronic immune thrombocytopenia were treated with Eltrombopag to dose in international guidelines. Results Approximately half (11/19:58%) of the patients benefitted from the treatment with Eltrombopag either by an increase of platelet levels at safe levels with a decrease in the frequency of bleedings which needed rescue treatment. Conclusion Thrombomimetic treatment options have strengthened the clinician’s hand where the regular treatment options became insufficient.

Devastative tongue bleeding due to self‐bite after dental extraction in a haemophilia A patient with inhibitor

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