Turk J Hematol: 26 (2)

Volume: 26 Issue: 2 - 2009

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EDITORIAL
1.	From the editor Aytemiz G�rgey Page 46 Abstract \| Full Text PDF

REVIEW
2.	Acute promyelocytic leukemia and differentiation therapy: molecular mechanisms of differentiation, retinoic acid resistance and novel treatments B�lent �zpolat Pages 47 - 61 Son 10 y�l i�erisinde, all-trans retinoik asidin (ATRA) bir akut miyeloid l�semi (AML) tipi olan akut promiyelositik l�semi (APL) tedavisinde kullan�lmaya ba�lanmas�, kanser tedavisinde k�kten de�i�iklik yapm�� ve diferansiyasyon tedavisi kavram�n�n ortaya ��kmas�na neden olmu�tur. A vitamininin (retinol) fizyolojik bir metaboliti olan ATRA, APL�li hastalar�n yakla��k %90��nda tam klinik remisyonlar� (KR) ind�kler. Sitotoksik kemoterap�tiklerin tersine, ATRA, APL�li hastalarda kemik ili�i hipoplazisi olu�umunu veya s�k olu�an �l�mc�l hemorajik sendromlar�n alevlenmesini �nleyerek, se�ici bir �ekilde promiyelositik l�semik h�crelerin normal gran�lositlere terminal diferansiyasyonunu ind�kler. Buna ra�men, sadece ATRA taraf�ndan ind�klenen remisyonlar ge�icidir ve �o�unlukla hastalar tedaviye diren� kazan�rlar, bu da pek �ok hastada hastal��n n�ks�ne neden olur; bu nedenle, ATRA� n�n tek ajan olarak kullan�m� s�n�rl� hale gelir. Bu nedenle, ATRA halen antrasiklin bazl� kemoterapi ile kombine haldedir ve bu rejim sadece kemoterapi kullan�m� ile kar��la�t�r�ld��nda, hastalar�n yakla��k %70�ini iyile�tirerek, hasta sa�kal�m�n� �nemli �l��de artt�rmaktad�r. Buna ra�men, APL hastalar�n�n halen %30�unda hastal�k n�ks etmekte ve 5 y�l i�erisinde �l�m ger�ekle�mektedir. Son zamanlarda, arsenik trioksit (As2O3)� in, sadece ATRA tedavisi ve klasik kemoterapiden sonra n�kseden APL hastalar�nda de�il, ayn� zamanda, primer APL hastalar�nda da KR�leri ind�klemede y�ksek oranda etkili oldu�u ispatlanm��t�r. ATRA�n�n yaz�l� kan�tlara dayanan klinik etkinli�ine ra�men, ATRA direncinin geli�mesinden sorumlu olan molek�ler mekanizmalar tam olarak anla��lmam��t�r. �nvitro ve klinik g�zlemlere dayanarak, ATRA�n�n h�zlanm�� metabolizmas�n�n ind�ksiyonu, azalm�� olan biyoyararlan�m ve plazma ila� d�zeyleri dahil �e�itli mekanizmalar, PML-RARα�n�n ATRA-ba�layan domain yap�s�nda nokta mutasyonu ve di�er molek�ler olaylar ATRA direncini a��klamak �zere �ne s�r�lm��t�r. Bu derlemede, APL�de ATRA direncinin �stesinden gelmek i�in, ATRA ile-ind�klenmi� miyeloid h�cre farkl�la�mas�n�n, direncin ve yeni klinik yakla��mlar�n molek�ler mekanizmalar�n� ele alaca��m. Incorporation of all-trans-retinoic acid (ATRA) into the treatment of acute promyelocytic leukemia (APL), a type of acute myeloid leukemia (AML), revolutionized the therapy of cancer in the last decade and introduced the concept of differentiation therapy. ATRA, a physiological metabolite of vitamin A (retinol), induces complete clinical remissions (CRs) in about 90% of patients with APL. In contrast to the cytotoxic chemotherapeutics, ATRA can selectively induce terminal differentiation of promyelocytic leukemic cells into normal granulocytes without causing bone marrow hypoplasia or exacerbation of the frequently occurring fatal hemorrhagic syndromes in patients with APL. However, remissions induced by ATRA alone are transient and the patients commonly become resistant to the therapy, leading to relapses in most patients and thus limiting the use of ATRA as a single agent. Therefore, ATRA is currently combined with anthracycline-based chemotherapy, and this regimen dramatically improves patient survival compared to chemotherapy alone, curing about 70% of the patients. However, 30% of APL patients still relapse and die in five years. Recently, arsenic trioxide (As2O3) was proven to be highly effective in inducing CRs not only in APL patients relapsed after ATRA treatment and conventional chemotherapy but also in primary APL patients. Despite the well-documented clinical efficacy of ATRA, molecular mechanisms responsible for development of ATRA resistance are not well understood. Based on in vitro and clinical observations, several mechanisms, including induction of accelerated metabolism of ATRA, decreased bioavailability and plasma drug levels, point mutations in the ATRA-binding domain of promyelocytic leukemia (PML)-retinoic acid receptor-alpha (RARα) and other molecular events have been proposed to explain ATRA resistance. In this review, the molecular mechanisms of ATRA-induced myeloid cell differentiation and resistance are discussed, together with novel clinical approaches to overcome ATRA resistance in APL. Abstract \| Full Text PDF

RESEARCH ARTICLE
3.	Premarital hemoglobinopathy screening in Kocaeli, Turkey: a crowded industrial center on the north coast of Marmara Sea Nazan Sarper, Vijdan �enkal, Fatih G�ray, �zcan �ahin, J�lide Bayram Pages 62 - 66 AMA�: Evlilik �ncesi hemoglobinopati taramas� hemoglobinopati kontrol program�n�n �nemli bir par�as�d�r. Bu �al��ma Kocaeli�deki hemoglobinopati s�kl��na ili�kin ilk rapordur. Y�NTEMLER: �al��ma Haziran 2005-Aral�k 2008 d�nemini kapsamaktad�r. Sa�l�k Bakanl��n�n ve �l Sa�l�k M�d�rl��n�n hemoglobinopati kontrol program� kapsam�nda evlenecek �iftlerin kanlar� nikah i�lemleri i�in ba�vurular� s�ras�nda al�nm��t�r. Tam kan say�mlar� ve hemoglobin varyant analizleri otomatik say�c� ve y�ksek bas�n�l� s�v� kromotografisi tekni�i ile �al��lm��t�r. Anormal hemoglobin ta��y�c�lar�na genetik dan��ma verilmi�tir. BULGULAR: Toplam 88888 ki�i taranm��t�r. β �thalasemi ta��y�c�l�� s�kl�� % 0.89, orak h�creli anemi ta��y�c�l�� s�kl�� % 0.05, y�ksek riskli �ift oran� %0.01 bulunmu�tur. SONU�: Kocaeli ilinde β �thalasemi ve orak h�creli anemi ta��y�c�l�� s�kl�� olduk�a d��kt�r. S�kl�k kuzey ve do�u Anadoludaki oranlar� ve Kocaeli�ye bu b�lgelerden olan g�� yans�tmaktad�r. Bu hastal�klardaki kronik transf�zyon gereksinimi, �elazyonun y�ksek maliyeti, organ hasarlar�, a�r�l� krizler ve di�er krizler, k�k h�cre naklinin ancak dokusu uyumlu karde�i olan s�n�rl� say�da hastaya yap�labilmesi, evlilik �ncesi tarama �al��malar�n�n Kocaeli gibi ta��y�c�l�k oranlar�n�n d��k oldu�u b�lgelerde de gerekli oldu�unu d��nd�rmektedir. OBJECTIVE: Premarital hemoglobinopathy screening is one of the important procedures of hemoglobinopathy control program. This is the first report about the prevalence of hemoglobinopathies in Kocaeli. METHODS: Study covered screening from July 2005 to the end of the December 2008. Under the auspices of the Ministry of Health and Regional Health authorities blood samples of the couples were obtained during admission to the wedding office. Complete blood counts and hemoglobin variant analysis were performed with automatic counter and high pressure liquid chromotography technique. A genetic counseling was given to carriers of abnormal hemoglobins. RESULTS: A total of 88888 people were screened. The frequency of β -thalassemia trait and sickle cell anemia trait were 0.89% and 0.05% respectively. The frequency of high risk couples was 0.01%. CONCLUSION: The prevalence of β -thalassemia trait and sickle cell anemia trait was quite low as a reflection of the frequency of eastern and northern Anatolia and migration to Kocaeli from these geographic regions. Although frequency is low, chronic transfusion requirement, high cost of chelating, organ damage, painful crisis and other crisis, availability of stem cell transplantation for a limited number of patients with compatible sibling donors justify premarital screening studies even in less prevalent regions as Kocaeli. Abstract \| Full Text PDF

4.	Utility of daily catheter-drawn blood cultures to predict catheter-related bacteremia in hematopoietic stem cell transplanted patients Maria Velasco, Montserrat Rovira, Josep Mensa, Manel Almela, Enric Carreras Pages 67 - 71 AMA�: Hangi bakteriyel kateter kolonizasyonunun sonu�ta kan dola��m� enfeksiyonuna yol a�abilece�ini belirleyecek tan�sal bir ara� mevcut de�ildir. Kateterden al�nan seri kan k�lt�rlerinde daha h�zl� �remenin veya tekrarl� pozitifli�in, ate�in ba�lang�c�ndan �nce, kateter ile ili�kili bakteriyeminin (K�B) habercisi olabilece�i tahmin edilmektedir. Y�NTEMLER: Prospektif g�zlemsel bir pilot �al��ma tasarlad�k. Hematopoietik k�k h�cre nakli (HKHN) yap�lan t�m hastalar 10 ay� a�k�n bir s�re boyunca prospektif olarak �al��maya dahil edildi. Kateterden g�nl�k kan k�lt�r� al�nd�. Her kan k�lt�r� i�in �reme zaman� ve bakteriyel izolasyon kaydedildi. H�zl� �reme g�r�len bir kan k�lt�r� (pozitif <12 saat) veya ard��k 4 g�n i�inde en az 2 pozitif �zde� k�lt�r, K�B riski i�in belirte� olarak tan�mland�. Bu belirtecin K�B �ng�rmedeki de�eri ara�t�r�ld�. BULGULAR: �al��maya toplam 82 hasta (843 kateter g�n�) dahil edildi. K�lt�rde h�zl� �reme veya tekrarl� �zde� k�lt�rler 20 hastada mevcuttu, bu hastalardan 15�i K�B klinik kriterlerine sahipti. K�lt�rlerinde h�zl� �reme g�r�lmeyen veya tekrarl� �zde� k�lt�rlere sahip olmayan 62 hasta aras�nda 11�i K�B klinik kriterlerine sahipti. Bu nedenle, tan�mlanan risk belirteci i�in, pozitif prediktif de�er %75, negatif prediktif de�er %82, sensitivite %70 ve spesifite %91 idi. Ate�in ba�lang�c�ndan �nce kateter ile ili�kili bir bakteriyemi olgusunu belirlemek i�in 62 kan k�lt�r� gerekli idi. SONU�: Hematopoietik k�k h�cre nakli yap�lan hastalarda kateter ili�kili bakteriyemiyi �ng�rmek i�in kateterden rutin al�nan kan k�lt�rlerinin kullan�m�, yararl� bir ara� gibi g�r�nmemektedir. OBJECTIVE: There is no diagnostic tool to identify which bacterial catheter colonization may eventually result in bloodstream infection. We speculated that a faster growth or repeated positivity of serial blood cultures drawn from the catheter might herald catheter-related bacteremia (CRB) before the onset of fever. METHODS: We designed a prospective observational pilot study. All patients who underwent hematopoietic stem cell transplantation (HSCT) were prospectively included in the study over 10 months. Daily catheter-drawn blood cultures (DBC) were performed. We recorded the growth time of each blood culture and bacterial isolation. A fast-growing blood culture (positive <12 hours) or at least 2 positive identical cultures within 4 consecutive days in the DBC were defined as a marker of risk for CRB. The value of this marker to predict CRB was investigated. RESULTS: A total of 82 patients (843 days of catheter) were included in the study. Fast- growing or repeated identical cultures were present in 20 patients; among them, 15 had clinical criteria of CRB. Among 62 patients without fast-growing or repeated identical cultures, 11 met the criteria of CRB. Consequently, for the defined marker of risk, the positive predictive value was 75%, negative predictive value 82%, sensitivity 70%, and specificity 91%. Sixty-two blood cultures were needed to detect one case of CRB prior to the onset of fever. CONCLUSION: The use of routinely drawn catheter-blood cultures does not seem to be a useful tool for predicting CRB in HSCT patients. Abstract \| Full Text PDF

5.	Serum Erythropoietin Levels in Pediatric Hematologic Disorders and Impact of Recombinant Human Erythropoietin Use Mualla �etin, Sule Unal, Fatma Gumruk, Aytemiz Gurgey, �i�dem Altay Pages 72 - 76 AMA�: Anemik hastalarda, aneminin �iddeti ve serum eritropoetin (sEpo) d�zeyleri aras�ndaki korelasyon bilinmektedir. Ancak, anemiye yol a�an farkl� hastal�k gruplar�nda, benzer hemoglobin seviyelerinde farkl� sEpo de�erleri �l��lmektedir ve bu durumun nedeni bilinmemektedir. Y�NTEMLER: Bu �al��mada 31 demir eksikli�i anemisi (DEA), 26 Fanconi anemi (FA), 21 talasemi intermedia (TI), 15 yeni tan� akut lenfoblastik l�semi hastas� (ALL) ile 12 sa�l�kl� kontrol�n hemoglobin ve sEpo de�erleri �l��lm��t�r. BULGULAR: B�t�n hastal�k gruplar�nda hemoglobin ve logaritmik sEpo seviyeleri aras�nda ters lineer bir ili�ki g�sterilmi�tir. Kovaryans analizinde d�zeltilmi� hemoglobine g�re en y�ksek sEpo de�erleri FA grubunda �l��l�rken, bunu s�ras�yla ALL, TI ve DEA gruplar� takip etmi�tir. SONU�: Fanconi anemili hastalar�n sEpo seviyelerine androgen kullan�m�n�n istatistiksel olarak anlaml� bir etkisinin olmamas� androjenin eritropoezi do�rudan uyard��na ve eritropoetin �zerinden geli�en eritropoeze etkisi olmad��na bir i�aret etmektedir. Sonu�lar bu hastal�k gruplar�nda eritropoetin eksikli�inin olmad��na i�aret etmekte ve egzojen eritropoetin kullan�m�n�n yarars�z olaca��n� g�stermektedir. OBJECTIVE: In anemic patients, the correlation between serum erythropoietin (sEpo) level and the severity of anemia has been reported previously. However, in different anemia groups, different sEpo levels are measured in patients with similar hemoglobin levels and the etiology of this situation could not be explained. METHODS: We evaluated hemoglobin and sEpo levels in 31 iron deficiency anemia, 26 Fanconi anemia (FA), 21 thallasemia intermedia (TI), 15 acute lymphoblastic leukemia (ALL) patients at presentation and 12 healthy controls. RESULTS: In all disease groups, an inverse linear correlation was shown between hemoglobin and logarhytmic sEpo level. The covariance analyses according to corrected hemoglobin levels exhibited the highest sEpo level in FA, followed by ALL, TI and iron deficiency anemia, sequentialy. CONCLUSION: There was no statisticaly significant difference of sEpo levels in FA patients in terms of androgen treatment and this finding supports that androgen affects erythropoisis directly, and has no effect on erythropoietin. The results indicate that there is no erythropoietin deficiency in the anemia of these patients and the admnistration of exogenous erythropoietin offers no clinical benefit. Abstract \| Full Text PDF

6.	Influence of cholesterol on shape parameters of erythrocytes in hyperglycemic subjects Babu Narayanan Pages 77 - 81 AMA�: De�i�ik seviyelerde hiperglisemiye sahip normo- ve hiper-kolesteroll� diyabetik hastalardan elde edilmi� kan �rneklerinde eritrositlerin morfolojik de�i�ikliklerini belirledik ve sonu�lar� sa�l�kl� bireylerin h�creleriyle kar��la�t�rd�k. Y�NTEMLER: �ekil analizi, eritrosit g�r�nt�lerinin i�lenmesiyle �l��len, ve tahmini alan, �evre ve form fakt�r�n� baz alan �ekil belirleyicileri ile yap�ld�. Normal bireylerden ve normo- ve hiper-kolesterol seviyelerine sahip glisemik bireylerden kan yaymalar� yap�ld�. G�r�nt�ler kenar g��lendirme, e�ikleme, filtreleme, s�n�r ��karma, yap� analizi ve tan�ma gibi g�r�nt� i�leme tekniklerinden sonra �ekil analizinde kullan�ld�. BULGULAR: Normal kolesterol seviyesine sahip diyabetik bireylerin eritrositlerindeki de�i�iklikleri belirleyen �ekil parametreleri, normal h�crelerin �eklinden anlaml� bir sapma g�sterdi. Hiperkolesterol seviyesine sahip diyabetik hastalar�n h�creleri normal kolesteroll� h�crelerden daha fazla sapma g�sterdi. SONU�: Bu de�i�iklikler, agregasyonun artmas�na ve eritrositlerin �ekil de�i�tirebilme �zelli�inde bir d��e yol a�ar ve b�ylece mikro dola��m ile ilgili komplikasyonlar artar. OBJECTIVE: We determined the morphological changes of erythrocytes in blood samples of diabetic patients with varying levels of hyperglycemia with normo- and hyper-cholesterol concentrations and compared them with cells of healthy subjects. METHODS: The shape analysis was carried out by shape descriptors based on projected area, perimeter and form factor, as measured by the processing of erythrocyte images. Blood smears were collected from normal subjects and from glycemic subjects with normo- and hyper-cholesterol levels. After image processing techniques like edge enhancement, thresholding, filtering, contour extraction, and pattern analysis and recognition, the images were used for shape analysis. RESULTS: The shape parameters, which quantified the changes in erythrocytes in diabetic subjects with normal cholesterol level, showed significant deviation from the shape of normal cells. Cells of diabetic subjects with hyper-cholesterol level showed more deviation than cells with normal cholesterol. CONCLUSION: These changes lead to hyper aggregation and to a decrease in deformability of erythrocytes and hence increase microcirculatory complications. Abstract \| Full Text PDF

7.	Role of cytosolic calcium and actin polymerization on agonist-induced secretion by the platelets of liver cirrhosis patients Annie-jeyachristy Sam, Geetha Arumugam, Surendran Rajagopal, Arulprakash Sarangapani, Jeevan Kumar Subburayan Pages 82 - 89 AMA�: Sirozun ba�l�ca komplikasyonlar�ndan biri trombosit aktivasyon bozuklu�u ile ili�kili olan varis kanamas�d�r. Bu ara�t�rmada, karaci�er sirozu olan hastalardan izole edilen trombositlerin, hemostaz i�in prokoag�lan sal�n�m�nda �nemli bir s�re� olan, sekretuvar kapasitesini belirledik. Ayr�ca, in vitro olarak agonistle uyar�lan trombositlerdeki sitosolik kalsiyumdaki (Ca2+) e� zamanl� de�i�iklikleri ve aktinin polimerizasyon durumunu da ara�t�rd�k. Bu �al��man�n amac�, karaci�er sirozunda trombositlerin sekretuvar fonksiyonunun aktin polimerizasyonunun seviyesinden ve sitosolik Ca2+ seviyesindeki de�i�ikliklerden etkilenip etkilenmedi�ini de�erlendirmekti. Y�NTEMLER: Trombositler in vitro olarak kollajen ile aktive edildi ve sekretuvar cevap �e�itli zaman aral�klar�nda trombosit s�spansiyonunun h�cre d�� s�v�s�na sal�nan n�kleotid, serotonin, pirofosfat (PPi) ve inorganik fosfat (Pi) seviyeleri ile de�erlendirildi. Sal�n�m boyunca, aktin polimerizasyonundaki de�i�imler, sitosolik Ca2+ seviyesindeki de�i�ikliklerle e� zamanl� olarak izlendi. BULGULAR: �stirahat halindeki trombositlerdeki bazal serotonin seviyesi hem kanamas� olan hem de kanamas� olmayan bireylerde normal ki�ilerle kar��la�t�r�ld��nda anlaml� olarak d��kt�. Adenin n�kleotidlerin seviyesi kanamas� olan bireylerde anlaml� olarak d��kt�. Sirotik trombositlerin sekretuvar kapasitesi d��k oldu�u bulundu ve d��k seviyelerdeki aktin polimerizasyonu ve sitosolik Ca2+ ile ili�kili olabilirdi. Kanamas� olan bireylerin trombositlerindeki de�i�imler kanamas� olmayan bireylerle kar��la�t�r�ld��nda anlaml� derecede y�ksekti. SONU�: Sirozda trombositlerin bozuk sekretuvar aktivitesi, k�smen trombosit �ekil de�i�ikli�i ve prokoag�lanlar�n sal�n�m� i�in gerekli olan, glob�ler aktinin filament�z aktine polimerizasyonunun d��k olmas�na ba�l� olabilir. Sitosolik Ca2+ seviyesi aktin polimerizasyonunu ve b�ylece agonistlere kar�� trombosit sekretuvar cevab�n� etkiliyor gibi g�r�nmektedir. OBJECTIVE: Variceal bleeding in cirrhosis is mainly due to platelet activation defect and secondary to coagulation defects. Secretion is an important process which release procoagulants for hemostasis. In the present investigation we have evaluated the secretory function of platelets in liver cirrhosis and also the simultaneous changes in cytosolic calcium (Ca2+) and the polymerization of actin in agonist- stimulated platelets in vitro. METHODS: Liver cirrhotic patients with (n=27) or without (n=23) bleeding complication were included in the study. Control subjects (n=50) were also utilized for the study to compare the analytical data. Platelets were activated by collagen in vitro and the secretory response was assessed by the levels of nucleotides, serotonin, pyrophosphate (PPi) and inorganic phosphate (Pi) secreted into the extracellular fluid of the platelet suspension at various time intervals. During the course of secretion the alteration in the polymerization of actin was monitored simultaneously with the changes in the cytosolic Ca2+ level. RESULTS: The secretory response of platelets to collagen was significantly low in both bleeders and non-bleeders when compared to that of normal subjects. During secretion, low level of actin polymerization and cytosolic Ca2+ level were observed in the platelets of bleeders than in non-bleeders and normal subjects. The low secretory capacity of cirrhosis platelets could be correlated with low levels of actin polymerization and cytosolic Ca2+. The alterations were highly significant in the platelets of bleeders when compared to those of non-bleeders. CONCLUSION: The defective secretory activity of platelets in cirrhosis bleeders might be partly due to low polymerization of G-actin to F-actin which is required for platelet shape change and for the release of procoagulants. Cytosolic Ca2+ level seems to influence actin polymerization and thereby impairs platelet secretory response to agonists in cirrhosis patients with bleeding complication. Abstract \| Full Text PDF

CASE REPORT
8.	The association of bladder myeloid sarcoma and unclassified myelodysplastic/myeloproliferative disease Mehmet Sonmez, �mit �obano�lu, Sevdag�l Mungan, Bircan S�nmez, Rasin �zyavuz Pages 90 - 92 Myeloid sarkom mesanede nadir g�r�len bir hastal�kt�r. Bu vaka takdiminde hemat�ri ile ba�vuran ve 2 ay �nce s�n�fland�r�lamayan myeloproliferatif/myelodisplastik hastal�k tan�s� alm�� 71 ya��nda erkek hastada mesanede diff�z tutulum ile seyreden myeloid sarkom tan�mland�. Hastan�n bat�n ultrasonografisi ve tomografisi normal olup, tan�sal ama�l� sistoskopide hiperemik ve �demli bir mukoza izlendi. Al�nan mukozal �rneklerin histopatolojik incelemesinde imm�nhistokimyasal olarak myeloperoksidaz ile boyanma g�steren blastik h�creler saptand�. S�n�fland�r�lamayan myeloproliferatif/myelodisplastik hastal�k ile kitle olmaks�z�n mesanede granulositik sarkom izlenen ilk vaka olarak tan�mland� ve literat�r e�li�inde tart��ld�. Myeloid sarcoma of urinary bladder is a rare disorder. We report a 71-year old man with hematuria. He was also under follow up for unclassified myeloproliferative/ myelodysplastic disorder, diagnosed 2 months ago. Abdominal ultrasonography and computed tomography findings were normal. Diagnostic cystoscopy revealed patchy areas of mucosal swelling with hyperemia. Histopathological examination of biopsies demonstrated a neoplasm composed of blasts showing myeloperoxidease positivity by immunohistochemistry. To our knowledge, current case is the first case of myeloid sarcoma without evidence of a mass lesion in the urinary bladder with a concurrent diagnosis of myelodysplastic /myeloproliferative disease, unclassifiable. Abstract \| Full Text PDF

9.	Hyperfibrotic myelodysplastic syndrome: a report of three cases from north India Prasenjit Das, Deepali Jain, Reena Das, Gurjeevan Garewal Pages 93 - 96 Yayg�n fibrozis miyelodisplastik sendromlarda (MDS) belirgin �ekilde nadir g�r�lmektedir. Biz burada �� nadir hiperfibrotik MDS olgusunu bildiriyoruz. Bu antite, de�i�ken klinik tablo ve k�t� prognozu nedeniyle kronik miyeloproliferatif hastal�klar (KMPH)-MDS grubu i�inde ayr� olarak s�n�fland�r�lmal�d�r. Extensive fibrosis in myelodysplastic syndromes (MDS) is distinctly infrequent. Herein, we report three rare cases of hyperfibrotic MDS. This entity should be classified separately in the chronic myeloproliferative disease (CMPD)-MDS group due to variable clinical presentation and poor prognosis. Abstract \| Full Text PDF

10.	Acute myeloid leukemia following radioactive iodine therapy for papillary carcinoma of the thyroid Jain Ankit, Premalata C. S., Saini K. S., Bapsy P. P., Sajeevan K. V., Tejinder Singh, Ullas Batra, Babu Govind, Lokanatha Dasappa, Suresh Atilli, Permeshwar R. Pages 97 - 99 Radyoaktif iyot (RA�) tedavisi tiroid malignitelerinin y�netiminde �nemli bir rol oynamaktad�r. L�semi, radyoaktif tedavinin �ok nadir bir komplikasyonudur. 100mCi alt�ndaki dozlar�n l�semiye neden oldu�unu bildiren �ok az olgu raporu vard�r. Biz, 80 mCi RA� ile tedavi edilen ve sonras�nda akut miyeoid l�semi geli�en bir tiroid papiller karsinom olgusunu bildiriyoruz. Bu nedenle uygulanan RA� dozuna bak�lmaks�z�n, RA� ile tedavi g�ren b�t�n tiroid karsinomlu hastalar�n periyodik hematolojik tetkikleri yap�lmal�d�r. Radioactive iodine (RAI) therapy plays an important role in the management of thyroid malignancies. Leukemia is a very rare complication of radioactive therapy. There are very few case reports with doses below 100 mCi causing leukemia. We report a case of papillary carcinoma of the thyroid treated with 80 mCi RAI who later developed acute myeloid leukemia. Thus, all patients with thyroid carcinoma treated with RAI should undergo periodic hematological examinations irrespective of RAI dose. Abstract \| Full Text PDF

LETTER TO EDITOR
11.	Compound heterozygosity for Hb D-Punjab / β-thalassemia and blood donation: case report Stamatia Theodoridou, Michael Alemayechou, Parthena Perperidou, Clio Sinopoulou, Theano Karafoulidou, Georgia Kiriakopoulou Pages 100 - 101 Abstract \| Full Text PDF

12.	Leishmaniasis in Yemeni children �inasi �zsoylu Page 102 Abstract \| Full Text PDF

13.	Premarital and antenatal screening of Hb-Los Angeles �inasi �zsoylu Page 103 Abstract \| Full Text PDF

IMAGES IN HEMATOLOGY
14.	Gingival and lip hypertrophy induced by cyclosporin A treatment in an aplastic anemia patient Illias Tazi Page 104 Abstract \| Full Text PDF

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