Objective: Therapy-related myeloid neoplasms (t-MN) account for approximately 10% to 20% of all cases of AML (acute myeloid leukemia), MDS (myelodysplastic syndrome) and MDS/MPN (myelodysplastic syndrome/myeloproliferative neoplasms), MDS, and MDS/MPN. In our study, we evaluated peripheral blood smear samples and hemogram values in breast cancer patients who were receiving adjuvant anthracycline regimens and were in remission. Materials and Methods:A total of 78 patients receiving anthracycline-based adjuvant chemotherapy treatment from Kayseri Research and Training Hospital and Mersin State Hospital were enrolled in the study. Their adjuvant treatments had been completed at least 18 months prior to the study. Results:Two patients complained of anemia (2.2%) (Hb<11 mg/dl), leukopenia was observed in seven patients (7.7%) (leukocytes<4000/ mm 3 ), and thrombocytopenia was observed in four patients (4.4%) (PLT<150.000/mm 3 ). In the blood smear samples, the following were observed: ovalomacrocytes (14%), macrocytes (37%), acanthocytes (1%), stomatocytes (12%), teardrops (12%), nucleated erythrocytes (1%), basophilic stippling (14%), and Howell-Jolly bodies (1%). Additionally, hypo-granulation (38%), Pelger-Huet abnormalities (26%), hypersegmentation (20%), immature granulocytes (8%), and blasts (6%) were observed. We also confirmed the presence of giant platelets (50%) and platelet hypogranulation (19%). Conclusion:According to the peripheral blood smear assessments in our study, we suggest that breast cancer patients should be evaluated for MDS in the early stages, starting from month 18, even if the automated blood counts are normal. ) saptandı. Ovalomakrositoz %14, makrositoz %37, akantositoz %1, stomatositoz %12, gözyaşı hücresi %12, çekir-dekli eritrosit %1, bazofilik noktalanma %14 ve Howell-Jolly cisimciği %1 olarak tetkik edildi. %38 oranında hipogranülasyon, %26 PelgerHuet anomalisi, %20 hipersegmentasyon, %8 immatür granülosit ve %6 blast vardı. Ayrıca %50 dev platelet ve %19 hipogranüle trombosit görüldü.Sonuç: Çalışmamızın periferik yayma değerlendirme sonuçlarına gore meme kanserli hastaların myelodisplazik sendrom açısından, otomatik hemogram değerleri normal olsa da, erken dönemde, 18. aydan başlayarak rutin araştırılmasını önermekteyiz.

No abstract

Giriş ve Amaç: Çalışmamızın amacı, trombotik trombositopenik purpura (TTP) ve hemolitik üremik sendromun (HÜS) tanısı sırasında, ADAMTS13 düzeylerini ve diğer hemoliz parametrelerini değerlendirmek ve sonuçlarla ayırıcı tanıya varabilmektedir. Yöntem ve Gereçler: 2014-2016 yılları arasında Eskişehir Osmangazi Üniversitesi Tıp Fakültesi İç Hastalıkları Kliniğinde mikroanjiyopatik hemolitik anemi (MAHA) kliniği ile başvuran ve tedavileri yapılan hastalar retrospektif olarak değerlendirildi. ADAMTS13 aktivitesi ve diğer laboratuvar testleri TTP (n=6), HÜS (n=5) ve diğer MAHA'li (n=8) hastalarda çalışıldı. Bulgular: HÜS ve diğer MAHA grupları ile karşılaştırıldığında TTP hastalarında, hem ADAMTS13 aktivitesi hem de trombosit sayıları istatistiksel açıdan anlamlı derecede düşük saptandı (p=0.014, p=0.028). ADAMTS13 aktivitesi ile tanı öncesi trombosit sayısı (p=0.001, r=0.693) ve serum kreatinin (p=0.008, r=0.589) düzeyleri arasında pozitif korelasyon saptandı. ADAMTS13 aktivitesi TTP grubunda en düşük düzeylerde, HÜS ve diğer grubunda ise orta-yüksek düzeylerde saptandı (p=0.048). Tartışma ve Sonuç: MAHA tanısı sırasında ciddi trombositopeni ve çok düşük ADAMTS13 aktivite düzeylerinin varlığı HÜS tanısı için bir bulgu değilken, TTP tanısını işaret etmektedir. Ilımlı bir trombositopeni, normal veya hafif/orta düzeyde azalmış ADAMTS13 aktivite düzeyleri ve artmış serum kreatinin düzeylerinin varlığı ise HÜS tanısını desteklemektedir. Anahtar sözcükler: ADAMTS13; hemolitik üremik sendrom; trombotik trombositopenik purpura.

Valproic acid has been used to treat epilepsy in children. The most common side effects are hepatotoxicity, anemia and thrombocytopenia. However the effect of valproic acid on fetal hemoglobin levels has not been revealed adequately. In this study it was aimed to search the effect of valproic acid on hemoglobin levels in children receiving valproic acid. In the present cross sectional study the research group consisted of children with epilepsy who had been receiving valproic acid monotherapy for at least six months. The control group contained children without epilepsy or valproic acid medication. The data from 44 patients and 57 controls were analyzed. The mean percentage of HbF of the study group and control group were 0.48 ±0.96 (%) and 0.25 ±0.61 (%) respectively, and there was no statistical difference between groups. There was a positive relation between blood valproic acid level and HbF levels. The present research showed that valproic acid has no effect on HbF levels. For children on valproic acid therapy, the detection of increased fetal hemoglobin levels must be evaluated carefully.

BackgroundThe most sensitive and gold-standard test used for the detection of antinuclear antibody (ANA) is accepted as the indirect immunofluorescence (IIF) test.1 International proposals, including the choice of rational examination, referred to as ”choosing wisely”, include significant efforts to reduce overuse of examinations such as the ANA.2 ObjectivesOur aim was to retrospectively analyse the distribution of the ANA test samples for clinical reasons according to the clinical departments and to determine the most frequently requested reasons and to draw attention to the rational the ANA request.MethodsDetection of ANA samples.Between January 2014 and August 2016, the results of the requested ANA test samples were screened for various reasons. The results of the first 4 divisions with the most common ANA test request and the reasons for the test were also analysed in detail (paediatric diseases were excluded). The ANA test was evaluated using the IIF method and the interpretation of the results was done according to the fluorescence intensity observed in the samples (+1 positive,+2 positive,+3 positive and +4 positive).Results11407 ANA samples were evaluated. The first 5 sections requiring ANA test most were as follows: Neurology 1917 (24.7%), dermatology 1825 (23.6%), rheumatology 1574 (20.3%), paediatric nephrology 1404 (18.1%) and haematology 1027 (13.3%). In all the sections dealing with children, the ANA test number was 2461 and the mean age of the patients was 12.7 years, while the number of ANA samples required in the entire adult patient group was 8946 and the mean age of the patients was 46.8 years. ANA positivity rates for neurology, dermatology, rheumatology and haematology departments are 14.9%, 15.4%, 32.6% and 14.1%, respectively. The interclinical positivity rate was statistically significant (p<0.0001). Positive +1,+2,+3 and+4 positivity rates were 33.5%, 27.8%, 22.2% and 16.3%, respectively, when all positive ANA results were evaluated in terms of titre. When positivity was evaluated in terms of ANA positivity rates/titre,+4 positivity was found to be the most common in the patients from the rheumatology department (135/262=51.5%) (p<0.0001).The reasons for ANA requests were determined according to ICD diagnostic codes. According to this; in neurology, headache, cerebrovascular event and multiple sclerosis; in dermatology urticaria, psoriasis and dermatitis; in rheumatology, SLE, arthritis and fibromyalgia; in haematology, anaemia and thrombocytopenia were the most common reasons for ANA requests.ConclusionsBased on specific recommendations and “choosing wisely”, the ANA test should be requested in patients with a high pre-test probability for autoimmune diseases. Raising awareness in terms of wisely choosing ANA test is needed in departments outside the rheumatology.References[1] Meroni PL, Schur PH. ANA screening: an old test with new recommendations. Ann Rheum Dis. 2010;69:1420–2.[2] Lesuis N, Hulscher ME, Piek E, Demirel H, van der Laan-Baalbergen N, Meek I, van Vollenhoven RF, den Broede...