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Introduction: Sinusitis is one of the most common infectious complications at the stages of hematopoietic stem cell transplantation. Diagnosis and treatment patients whith cytopenia often causes difficulties for otorhinolaryngologists. Objective: To analyze the possibility of puncture of the maxillary sinuses in patients whith cytopenia after hemopoietic stem cells transplantation. Materials and methods. The case histories of 350 patients whith rhinosinusitis, who received treatment at the Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation from January 2017 to June 2018 were analyzed. Of these patients, 41 (11%) (11 – 62 y.o.) underwent puncture of the maxillary sinuses. The control group included 59 immunocompetent patients undergoing puncture treatment for sinusitis. Results: The clinical picture of sinusitis in patients with cytopenia was different from the classical one. In cases of severe anemia (<80 g/l), paleness of the mucous membranes of the nasal cavity prevailed; with extremely severe neutropenia (<0.5 x 109/l), and leukopenia (<1.0 x 109/l) in the vast majority of patients, the nasal discharge was mucopurulent. 10% patients with drug immunosuppression and agranulocytosis have pronounced edema and hyperemia of nasal soft tissues. In 19.5% patients, who underwent puncture, severe thrombocytopenia (<25 x 109/l) was observed. In 3 (7%) patients, significant bleeding was observed after puncture. In punctate we observed Str. Viridans (26.8%), Pseudomonas spp. (14.6%), and Klebsiella pneumonia (12.2%) of cases. Conclusion: Sinusitis with cytopenia is prone to atypical course. Symptoms in these conditions can vary from scanty to pronounced. Puncture of the maxillary sinuses in such patients can be performed according to indications.

The article presents the results of studying the features of the endoscopic picture of acute rhinosinusitis in patients with anemia and neutropenia, who underwent hematopoietic stem cell transplantation (HSCT). The questions of the influence of the level of hemoglobin on the presence of hyperemia of the mucous membrane of the nasal cavity, as well as the influence of the level of neutrophils on the presence of pus in the exudate in rhinosinusitis, are being studied. The study was carried out based on the Clinic of the Raisa Gorbacheva Memorial Research Institute of Pediatric Oncology, Hematology, and Transplantation. The study included 49 episodes of rhinosinusitis in HSCT recipients diagnosed in the period from day –7 to day +30 after transplantation. The control group included 46 patients with rhinosinusitis undergoing treatment at the otorhinolaryngology clinic. In the course of the study, the influence of the level of neutrophils on the presence of purulent discharge in rhinosinusitis was established. The threshold value, below which the chances of having pus in the exudate significantly decreased, was 2.6 x 109/l (sensitivity and specificity of the method – 81.6 and 76.1%, respectively). It was also found that hemoglobin level affects the presence of hyperemia of the nasal mucosa. It was shown that at a hemoglobin level less than 119 g/l, the odds of presence of hyperemia of the nasal mucosa significantly decreased (sensitivity 77.6%, specificity 95.5%). Thus, in patients with anemia and neutropenia, one should remember the likelihood of the absence of pus and hyperemia of the nasal mucosa in the presence of rhinosinusitis. These criteria should not be the main ones in such a group of patients, and the diagnosis should be based on the results of an X-ray examination and the presence of other symptoms.

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