Mustafa Koroglu

A life-saving therapy in Class I HELLP syndrome: Therapeutic plasma exchange

HELLP syndrome, which can affect multiple organ systems and cause maternal and fetal mortality, is a serious complication of pregnancy characterized by microangiopathic hemolytic anemia, elevation of liver enzymes, and thrombocytopenia. Delivering the infant usually suffices for the treatment of this syndrome. In cases with Class I HELLP syndrome, however, the clinical picture may rapidly deteriorate despite delivery. In this paper we presented the outcomes with the use of therapeutic plasma exchange in cases with class I HELLP syndrome. This study included 21 patients diagnosed with the Class I HELLP syndrome at Inonu University Faculty of Medicine, Department of Hematology between 2011 and 2014. A central venous catheter was placed and plasma exchange therapy was begun in patients unresponsive to delivery, steroid, and supportive therapy (blood and blood products, antihypertensive therapy, intravenous fluid administration, and antibiotics) within 24 hours after the diagnosis of Class I HELLP syndrome according to the Mississippi Criteria. All patients underwent therapeutic plasma exchange for three sessions each with a 1:1 volume. Hemogram and biochemical parameters of the patients were evaluated before and after the procedure. According to results, there was a statistically significant decrease in total bilirubin, LDH, AST, and ALT levels whereas a significant increase in platelet count was observed. Hemoglobin levels were increased, although this increase was not statistically significant. HELLP syndrome is primarily treated with the delivery of infant; however, some cases may show disease progression despite completion of delivery. As a potential cause of both maternal and fetal mortality, HELLP syndrome condition should be aggressively treated. Therapeutic plasma exchange is one of the available treatment options. Our study has found that postpartum use of plasma exchange therapy within 24 hours is an efficient and lifesaving treatment choice in Class I HELLP syndrome.

Leukapheresis in acute myeloid leukemia patients with hyperleukocytosis: A single center experience

Hyperleukocytosis is defined as WBC count above 100,000/mm(3) in peripheral blood. Increased WBC count leads to leukocyte aggregation, increased blood viscosity, and consequently results in stasis in small blood vessels. Ultimate neurological, pulmonary, gastrointestinal complications, coagulopathy, and tumor lysis syndrome cause increase in morbidity and mortality. Leukapheresis is a treatment modality used for hyperleukocytosis. In patients presenting with hyperleukocytosis the indications for leukapheresis were accepted as having symptoms of leukostasis and prophylactic. Indications for leukapheresis in prophylactic group evaluated according to WBC count. We report a single center experience about leukapheresis in managing 31 AML patients with hyperleukocytosis. In addition to demographic characteristics, disease-related clinical and laboratory findings of the patients were recorded. Survival rates were also calculated. Ten patients were female. The most common of AML subtype was AML-M2. The median number of leukapheresis per patient was 2 and totally 60 leukapheresis cycles were performed in all patients. There was a significant decrease in WBC count and LDH level after leukapheresis as compared with the baseline values (p < 0.05). Early and total mortality were 16.1% and 58.0%, respectively. Alive and died patients were evaluated according to baseline WBC, LDH; increased WBC count and LDH level were found in died patients (p < 0.05). According to leukapheresis indications, patients were divided into two groups: 14 patients in symptomatic leukostasis, 17 patients in prophylaxis. No statistically significant differences were noted between both groups in leukapheresis effectiveness, mean survival time, early and total mortality rate (p > 0.05). None of our patients suffered serious side effects and tumor lysis syndrome during or after apheresis. Leukapheresis is an effective and safe approach to reduce WBC counts in patients with AML with hyperleukocytosis. Further evidence-based data obtained from larger sample sizes are required to better understand the impact of prophylaxis leukapheresis on early and total mortality of AML patients with hyperleukocytosis.

An unexpected complication of bone marrow aspiration and trephine biopsy: arteriovenous fistula.

Objective: To report a case of arteriovenous fistula (AVF) following bone marrow aspiration and trephine biopsy. Clinical Presentation and Intervention: A 76-year-old man was diagnosed with acute myeloblastic leukemia. Pain and hematoma were detected in his left leg and hip 4 days after bone marrow aspiration and trephine biopsy. A pelvic arteriography was performed, and a diagnosis of AVF was made. Conclusion: This case shows that clinicians should be aware of AVF, especially in cases with refractory bleeding after bone marrow aspiration and trephine biopsy despite normal blood coagulation parameters.

Therapeutic plasma-exchange in hematologic disease: Results from a single center in Eastern Anatolia

Therapeutic plasma-exchange (TPE) is used as primary and adjunctive therapy in treatment of several hematologic diseases. We retrospectively evaluated the results of TPE in hematologic diseases during 2008-2012. A total of 301 TPE procedures were performed in 44 patients (19 male and 25 female, with mean age of 50.6±15years). Fifteen of 44 patients had thrombotic thrombocytopenic purpura (TTP), 14 patients had HELLP syndrome (Hemolysis Elevated Liver enzymes, Low Platelet count), 10 patients had multiple myeloma-hyperviscosity and the rest five patients had snake bite. Fresh frozen plasma (FFP) was used as replacement fluid. Complete response (CR) was achieved on 13 patients (87%) in primarily TTP. CR was achieved in all other three diseases. Total complications were detected in 8.1% of the TPE procedures. Adverse events (AEs), were seen in 5.4% of all procedures. None of the patients died from any complication. AE occurred in 4% (Grade-I), 1% (Grade-II), and 0.3% (Grade-III) of the procedures. The most common AE were nausea/vomiting, hypotension, pruritus and abdominal pain. TPE is effectively and safely carried out in our center in hematologic diseases.

Leukapheresis Treatment in Elderly Acute Leukemia Patients With Hyperleukocytosis: A Single Center Experience

Leukapheresis is an invasive treatment modality used for hyperleukocytosis. Various drugs and fluids are used during the leukapheresis. Aging itself and associated factors such as increased comorbidity, decreased tolerance to drugs, increased drug toxicity give rise to the application of other treatment modalities in elderly patients. Treatment of acute leukemia in the elderly differs from young patients. Consequently, we assumed that outcome, effectiveness, and side effects of leukapheresis treatment used for acute leukemia patients with hyperleukocytosis may be different in elderly compared to younger patients.

Hermansky-Pudlak Syndrome: A Case Report

Objective. The aim of this paper is to report the case of a patient diagnosed with Hermansky-Pudlak syndrome, as a result of bleeding diathesis. Clinical Presentation and Intervention. A 23-year-old male presented with recurrent epistaxis and, upon physical examination, was found to be remarkable for albinism and suborbital ecchymosis. The absence of dense bodies in the platelets was demonstrated using electron microscopy. This patient was (slowly) administered one unit of a platelet suspension, and his bleeding decreased considerably. Conclusion. This case shows that Hermansky-Pudlak syndrome should be considered in the differential diagnosis of a patient presenting with bleeding diathesis, when the clinical presentation also includes oculocutaneous albinism and visual problems.

Primarily unknown origin adenocarcinoma metastasis in bone marrow presenting with thrombotic thrombocytopenic purpura: A case report

We report a case of thrombotic thrombocytopenic purpura refractory to plasma exchange treatment. In bone marrow examination non hematopoetic cell groups have seen. But the primary tumor could neither be located endoscopically nor in imaging examinations. Upon the bone marrow biopsy confirm the adenocarcinoma metastasis an objective improvement have achived in the blood picture after polychemotherapy.

DHAP plus filgrastim as an effective peripheral stem cell mobilization regimen for autologous stem-cell transplantation in patients with relapsed/refractory lymphoma: A single center experience.

This study aimed to evaluate the efficiency of DHAP regimen plus filgrastim for mobilization of stem cells in patients with recurrent and/or refractory lymphoma. Thirty-four patients who took DHAP as salvage therapy prior to autologous stem cell transplantation were included. After chemotherapies, 2 cycles of DHAP plus filgrastim were administered to the patients. Stem cells from 32 patients (94%) were collected on median 11th day (8-12), and the median collected CD34(+) cell dose was 9.7 × 10(6)/kg (range 3.8-41.6). DHAP plus filgrastim was found to be an effective chemotherapy regimen in mobilizing CD34(+) stem cells into the peripheral.

Etiologic evaluation of 1012 patients admitted with thrombocytopenia.

Introduction: Thrombocytopenia is the situation where the number of thrombocytes is less than 150.000/ μL. This may result due to decreased thrombocyte production, increase in the destruction of thrombocytes and differentiation in distribution of thrombocytes. Hereditary and acquired diseases both contribute to the condition, but the acquired reasons are more common in older patients. In this study we aimed to present the patients’ data with thrombocytopenia in the eastern Turkey and the underlying diseases that cause thrombocytopenia in order to contribute to literature. Material and Methods: In this study, we retrospectively aimed to evaluate the etiology of thrombocytopenia at 1012 patients who admitted to Inonu University Medical Faculty Turgut Ozal Medical Center Hematology outpatient clinic, hematology service, emergency department and the ones who were consulted from other departments in the hospital. We collected data of patients for whom we searched the aetiology of thrombocytopenia as Department of Hematology. Results: Total of 1012 patients, of whom 508 were female and 504 were male, were included to the study. The mean age was 51±20 years. The mean number of the thrombocytes was 64.28±43.05 /mL. The mean number of leucocytes was 13.89±32.71 /μL. The mean level of hemoglobin was 11.22±3.03 g/dL. Leukaemia, infections and the immune thrombocytopenias represented most of the cases, and the other reasons of Research Article British Journal of Medicine & Medical Research, 4(1): 104-113, 2014 105 thrombocytopenia were drugs, chronic liver diseases, megaloblastic anemias, pseudothrombocytopenia, thrombotic microangiopathies and other diseases. Conclusion: The reasons of thrombocytopenia may differ according to geographic distribution and step level of health centers. It’s an expected situation for thrombocytopenia reasons that the high rate of infections can be accused in developing countries and malignant diseases to be the first reason in developed countries.

Decitabine induced localized maculopapular eruption.

Aims: Decitabine is a drug for the treatment of myelodysplastic syndromes and acute myeloid leukemia. It has a side-effect profile affecting many systems, including dermatologic side effects. Herein, we report a case with a maculopapular-type drug eruption due to decitabine. Presentation of Case: A 51-year-old previously healthy woman was diagnosed with myelodysplastic syndrome RAEB-1, and decitabine [20mg/m2/day/i.v (5 days with cycles repeated every 28 days)] chemotherapy was given. On the seventh day of the second treatment cycle, we diagnosed a maculopapular eruption on the front of the left arm. The patient presented with skin that was itchy, puffy, maculopapular and erythematous. The rash faded when pressed and tended to coalesce with each other, indicating a drug eruption due to decitabine. Maculopapular type drug reaction depending on decitabine was considered. The eruption improved remarkably within 10 days, and the patients rash had disappeared by the 17 day of treatment. Discussion: Drugs occasionally induce cutaneous side effects. Ecchymosis, rash, erythema, petechiae skin lesion and pruritus have been described in decitabine’s Case Study British Journal of Medicine & Medical Research, 4(4): 1002-1007, 2014 1003 prospectus. Maculopapular eruptions can affect all age groups. This type of eruption is common with certain drugs as well as with several diseases and medical conditions including scarlet fever, measles, rubella, secondary syphilis, parvovirus B19 and heat rash. A number of drugs may cause the appearance of maculopapular eruptions. Conclusion: Practitioners should be aware of this rare, but potentially serious, adverse event, especially as decitabine is commonly used for myelodysplastic syndromes and acute myeloid leukemia.