Meltem Olga Akay

Isolated Granulocytic Sarcoma of the Breast after Allogeneic Stem Cell Transplantation: A Rare Involvement Also Detected by 18FDG-PET/CT.

Granulocytic sarcoma is a tumor consisting of myeloid blasts with or without maturation that occurs at an anatomical site other than bone marrow. Most frequently affected sites are skin, lymph nodes, gastrointestinal tract, bone, soft tissue and testes. AML may manifest as granulocytic sarcoma at diagnosis or relapse. Although it has been considered to be rare relapse as granulocytic sarcoma after stem cell transplantation is being increasingly reported. However it is rare without bone marrow involvement and in AML M6 subtype. Breast is also a rare involvement. We report a 30-year-old woman with AML M6 relapsed 16 months after allogeneic stem cell transplantation as a granulocytic sarcoma in right breast without bone marrow involvement. She was treated with systemic chemotherapy but died of sepsis. 18FDG-PET/CT images were also obtained and detected lesions other than detected by breast ultrasound. The incidence of granulocytic sarcoma may increase if suspected or new diagnostic modalities are performed.

Multicenter retrospective analysis regarding the clinical manifestations and treatment results in patients with hairy cell leukemia: twenty-four year Turkish experience in cladribine therapy

In this multicenter retrospective analysis, we aimed to present clinical, laboratory and treatment results of 94 patients with Hairy cell leukemia diagnosed in 13 centers between 1990 and 2014. Sixty‐six of the patients were males and 28 were females, with a median age of 55. Splenomegaly was present in 93.5% of cases at diagnosis. The laboratory findings that came into prominence were pancytopenia with grade 3 bone marrow fibrosis. Most of the patients with an indication for treatment were treated with cladribine as first‐line treatment. Total and complete response of cladribine was 97.3% and 80.7%. The relapse rate after cladribine was 16.6%, and treatment related mortality was 2.5%. Most preferred therapy (95%) was again cladribine at second‐line, and third line with CR rate of 68.4% and 66.6%, respectively. The 28‐month median OS was 91.7% in all patients and 25‐month median OS 96% for patients who were given cladribine as first‐line therapy. In conclusion, the first multicenter retrospective Turkish study where patients with HCL were followed up for a long period has revealed demographic characteristics of patients with HCL, and confirmed that cladribine treatment might be safe and effective in a relatively large series of the Turkish study population. Copyright

Nodular lymphocyte predominant Hodgkin's lymphoma in daily practice: A multicenter experience

Nodular lymphocyte predominant Hodgkins lymphoma (NLPHL) is a rare subtype of Hodgkins lymphoma. In this study, we aimed to investigate the clinical features and therapeutic outcomes of patients with NLPHL who were diagnosed at different institutes in Turkey.

The Evaluation of Hydroxyethyl Starch (6% HES 130/0.4) Solution's Potential Preventive Effects on Coagulation Status in Women with Gynecologic Malignancies Using Rotation Thromboelastography.

Objective: The aim of this study was to determine the effects of in vitro hemodilution with 6% hydroxyethyl starch (HES) 130/0.4 solution on the coagulation status of women with gynecologic malignancies by using rotation thromboelastogram (ROTEM®). Materials and Methods: Twenty-two patients with gynecological tumors scheduled for anesthesia were enrolled. Blood samples were diluted by 20% with 6% HES (130/0.4) solution. Results: In the INTEM assay, clotting time (CT) (p<0.01) and clot formation time (CFT) (p<0.001) were significantly increased and maximum maximum clot formation (MCF) (p< 0.001) was significantly decreased in HES hemodilution compared with the undiluted control samples. In the EXTEM assay, there was a similar significant increase in increase in CFT (p<0.01) and a decrease in maximum a decrease in MCF (p<0.01) in HES hemodilution when compared with control samples. Conclusion: HES 130/0.4 solution causes significant hypocoagulable changes in the thromboelastographic profile of gynecologic cancer patients in vitro.

Does tramadol affect coagulation status of patients with malignancy

Aim: The study investigated the direct effects of tramadol on the coagulation status of women with gynecologic malignancies in vitro. Materials and Methods: Citrated whole-blood samples from 21 patients with gynecologic tumors were spiked ex vivo with 2 or 6 μl/ml tramadol. Thrombelastography (TEG) analysis was performed using ROTEM® to assess clotting time (CT), clot formation time (CFT) and maximum clot formation (MCF). Results: In the INTEM assay, CT (P < 0.05) and CFT (P < 0.01) were significantly prolonged with tramadol at a 6 μl/ml concentration compared with baseline. There were no significant differences in MCF values between the baseline and the tramadol-treated samples (P > 0.05). Blood medicated with tramadol (6 μl/ml) clotted slowly (increased CT and CFT). Conclusion: The changes observed by TEG demonstrated that tramadol impairs hemostasis in a concentration-dependent manner in the whole blood of women with gynecologic malignancies in vitro.

Rapid molecular cytogenetic diagnosis of transfusion associated graft-versus-host disease by fluorescent in situ hybridization (FISH)

Transfusion associated graft-versus-host disease (TA-GVHD) is a rare, dreadful complication of transfusion in immunocompromized and immunologically competent individuals. The diagnosis is often delayed, because of lack of awareness and the non-specific clinical features. We describe a rapid molecular cytogenetic analysis of FISH for the diagnosis of two cases of TA-GVHD with sex-mismatched donors. The use of FISH is a rapid and sensitive technique for the early diagnosis of TA-GVHD when the recipient and donor are of different gender.

Recognizing Pinch Purpura As The First Manifestation Of AL Amyloidosis

A 74-year-old female presented with a 6-month history of easy bruising as manifested by purpura after minor trauma to her face. Her physical examination was unremarkable except for the presence of pinch purpura scattered on her face (Figure 1). Laboratory tests showed leukocytes of 8100/μL, hemoglobin of 11.2 g/dL, platelets of 208,000/μL, prothrombin time of 11 s (normal range: 11.2-13.0 s), activated partial thromboplastin time of 25 s (normal range: 23.0-33.0 s), and erythrocyte sedimentation rate of 72 mm/h. Upon further workup, the presence of IgG lambda monoclonal gammopathy of the serum and lambda monoclonal light chain was found in urine immunofixation electrophoresis. Bone marrow biopsy revealed 7% lambda-restricted plasma cell infiltration, showing green birefringence with Congo red stain and vascular amyloid P deposition (Figure 2). There were no CRAB symptoms, organ dysfunction, or organomegaly. Echocardiography and pro-Btype natriuretic peptide results were normal. A diagnosis of amyloid light-chain (AL) amyloidosis initially presenting with purpura was made and a chemotherapy regimen of bortezomib and dexamethasone was started. Complete remission was achieved after six courses of chemotherapy and the purpuric lesions disappeared.

THU0141 Can we predict thrombotic tendency in rheumatoid arthritis: a thromboelastographic analysis

Background Arterial and venous thromboembolism were proven to be increased in cases with rheumatoid arthritis (RA) (1). It would be interesting to predict thrombosis in these patients by a laboratory test. Rotational thromboelastography (ROTEM) is a viscoelastometric clotting test to evaluate the kinetics of clot formation and fibrinolysis which provides global information on cellular and soluble procoagulant/anticoagulant protein interactions. Objectives Our aim was to determine the thrombosis predisposition in RA patients by thromboelastography and to identify the possible clinical and laboratory risk factors for thrombotic tendency in RA patients. Methods 85 RA patients (mean age: 54.12±13 yrs; female: 66 (77.6%) diagnosed based on 2010 ACR/EULAR classification criteria were sequentially recruited. Patients were receiving either conventional synthetic disease modifying antirheumatic drugs (csDMARD) or were receiving biological treatments. Age- and gender matched 35 healthy individuals were enrolled as a control group. Complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels were measured and DAS-28 scores were calculated. ROTEM was applied at the same time and clotting time (CT, seconds), clot formation time (CFT, seconds), and maximum clot firmness (MCF, mm) were determined. A shorter CT and/or CFT values and/or a higher MCF levels imply tendency towards hypercoagulability. Results RA patients with a higher disease activity were found to have a shorter I-CFT and a higher I-MCF (p values p=0.020, p=0.033, respectively). Correlation analysis revealed shorter I-CFT and E-CFT and higher I-MCF and E-MCF in those with more active disease, hence indicating a higher tendency to thrombosis. DAS-28 score, high level of CRP, and increased platelet count were identified as variants affecting thromboelastography in favor of thrombosis susceptibility. Conclusions Disease activation in RA patients may lead to hypercoagulability, independent of the ongoing medication of patients. Considering the fact that the predictive value of ROTEM parameters for further thrombosis, additional studies are needed whether pro-thrombotic state in RA may herald thrombosis in the presence of inflammation. References Mameli A, Barcellona D, Marongiu F. Rheumatoid arthritis and thrombosis. Clin Exp Rheumatol. 2009;27:846–55. Acknowledgements None. Disclosure of Interest None declared

SAT0333 Hemostatic Mechanisms May Play A Role in The Development of Thrombosis in Male Patients with Behcet's Disease: A Thromboelastographic Analysis

Background In Behcets disease (BD), vascular involvement is seen frequently in young male BD patients. However, its reason is not well known. Objectives Our aim was to compare thrombotic tendency according to gender by using the modified Rotational Thromboelastography parameters and platelet-leucocyte complex levels. Methods 126 BD patients (71 male, 55 female; mean age:41±9 yrs) who met ISSG criteria for Behcets disease were included into study. This group was divided into 3 subgroups as non-thrombotic (n=73), acute thrombotic (n=25) and chronic thrombotic group (n=28). As disease control and healthy control group, 23 patients with vasculitis (16 female, 7 male; mean age 49±16 yrs), 8 patients with thrombosis (3 female, 5 male; mean age:55±11 yrs) and 25 healthy individuals (11 female, 14 male; mean age:37±10 yrs) were included to study. By using the modified rotation thromboelastogram, clotting time (CT), clot formation time (CFT) and maximum clot formation (MCF) were determined by INTEM and EXTEM analysis. Thrombocyte-leucocyte complexes and thrombocyte activation marker (p62) were investigated by flow-cytometric method. Results In terms of thrombocyte-leucocyte complexes and P62 levels, no significant difference was found in female BD patients vs male BD pts, active BD pts vs inactive BD pts and thrombotic BD pts vs non-thrombotic BD pts. Thrombocyte-leucocyte complexes levels were higher in vasculitis group than BD group (p<0.01) and HC group (p<0.04). I-MCF was significantly prolonged in male BD patients than female BD patients. E-CFT was found to be shorter in male BD patients compared to female BD patients. E-MCF was statistically prolonged in male BD patients. In inactive male BD patients, while I-CFT was shorter than HC individuals, I-MCF and E-MCF were statistically prolonged than HC (p<0.02, p<0.03), respectively. However, No significant differences were found between inactive female BD patients and HC in terms of all ROTEM parameters. In active BD patients, E-CFT was shorter (p<0.02) and E-MCF was significantly prolonged than those of inactive BD patients (p<0.005). Conclusions These results support that male BD patients have a hypercoagulable state compared to female BD patients which may be an explanation why male patients are prone to thrombotic complications. Disclosure of Interest None declared