[Investigation of SARS-CoV-2-Specific Humoral and Cellular Immunity Values in Health Care Workers with COVID-19 Disease and Administered with COVID-19 Vaccine]. / COVID-19 Geçiren ve COVID-19 Asisi Olan Saglik Çalisanlarinda SARS-CoV-2'ye Özgü Humoral ve Hücresel Bagisiklik Degerlerinin Arastirilmasi.

For limiting the coronavirus disease-2019 (COVID-19) pandemic, the effects on both humoral and cellular immune responses due to vaccines and previous infection should be taken into consideration. In some of the studies about the humoral immune response of the virus and different vaccines, it has been suggested that there can be a discordance between cellular and humoral immune responses during COVID-19 infection. The aim of this study was to determine the effects of humoral and cellular immune responses against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) antigens in three groups of healthcare workers (HCWs) who were vaccinated with two doses of inactivated virus vaccine (CoronaVac), non-vaccinated and recovered COVID-19 infection and non-infected healthy controls by comparing the variables of gender and age and to examine the relationships between them. In this study, the antibody recognizing the receptor binding domain (RBD) of the spike (S) glycoprotein (IgG-S), nucleocapsid protein (IgG-N) of SARS CoV-2 and Interferon Gamma (IFN-γ) titres were determined among non-infected and vaccinated with two doses of inactivated virus vaccine (IVV) (n= 56, 1st group: 27 men, 29 women), non-vaccinated and COVID-19 convalescents (CG) (n= 41; 2nd group: 21 men, 20 women) and non-vaccinated and non-infected healthy controls (HCG) (n= 23, 3rd group: 10 men, 13 women) in 120 HCWs. Diagnosis of all the participants in COVID-19 CG was confirmed for SARS CoV2 infection with reverse transcription polymerase chain reaction (RT-PCR) test according to manufacturer's instruction (Bio-speedy® SARS CoV-2 Double Gene RT-qPCR, Bioeksen R and D Technologies, Turkey). IgG-S and IgG-N antibody levels were determined quantitatively by Abbott Architect i2000 (Abbott Laboratories, Abbott Park, IL, USA) system. (Qiagen, MD, USA). IFN-γ levels were determined by using the QuantiFERON SARS-CoV-2 Starter Blood Collection Tubes (Qiagen, MD, USA). All statistical data analysis were conducted using SPSS (version 22, IBM Corp., Armonk, NY, USA). Student's independent t-test or Mann-Whitney U test was used for the differences between bivariate groups and Spearman Rank correlation was used to evaluate the monotonic relationship between nonnormally distributed data sets. Spearman rho > 0.7 denotes high, 0.7 > rho > 0.5 moderate and rho > 0.05 was considered as significant. For each of the immunity parameters, there were no significant differences between males and females in the IVV group, as well as in the CG. In neither of the groups age and immunity parameters were found to be highly correlated. All three immunity parameters of males in CG and IVV groups significantly differed from each other. Although humoral immunity parameters of females between CG and IVV groups did not show any significant difference, the IFN-γ titres significantly differed from each other. There were no significant differences in the IgG-S titres between CG and IVV combined gender groups. However, IgG-N and IFN-γ titres significantly differed from each other between CG and IVV groups. Antibody and particularly IFN-γ levels in two dose CoronaVac vaccinated group were less pronounced in comparison to the observed responses in COVID-19 convalescents group, indicating that CoronaVac may induce substantially less robust and persistent cellular and humoral responses than natural SARS-CoV-2 infection.

Clinical Accuracy of Instrument-Read SARS-CoV-2 Antigen Rapid Diagnostic Tests (Ag-IRRDTs).

This systematic review (PROSPERO registration number: CRD42021282476) aims to collect and analyse current evidence on real-world performance based on clinical accuracy of instrument-read rapid antigen diagnostic tests (Ag-IRRDTs) for SARS-CoV-2 identification. We used PRISMA Checklist and searched databases (PubMed, Web of Science Core Collection and FIND) for publications evaluating the accuracy of SARS-CoV-2 Ag-IRRDTs as of 30 September 2021, and included 40 independent clinical studies resulting in 48 Ag-IRRDT datasets with 137,770 samples. Across all datasets, pooled Ag-IRRDT sensitivity was 67.1% (95% CI: 65.9%-68.3%) and specificity was 99.4% with a tight CI. Pooled sensitivity and specificity of SARS-CoV-2 Ag-IRRDTs did not demonstrate a significant superiority over SARS-CoV-2 rapid antigen tests which do not require a reader instrument, even in the case where surveillance and screening datasets were excluded from the analysis. Nevertheless, they provide connectivity advantages and remove operator interface (in results-reading) issues. The lower sensitivity of certain brands of Ag-IRRDTs can be overcome in high prevalence areas with high frequency of testing. New SARS-CoV-2 variants are major concern for current and future diagnostic performance of these tests.

[The Second Shot of CoronaVac Vaccine May Cause Reduction of Antibody Levels in People who Previously had COVID-19]. / CoronaVac Asisinin Ikinci Dozu COVID-19 Geçirmis Kisilerde Antikor Düzeylerinin Düsmesine Neden Olabilir.

The CoronaVac vaccine is an inactivated type two-dose regimen vaccine developed and manufactured by Sinovac Life Sciences Company, in China. It has already been used in China's vaccination program, while 21 other countries (including Indonesia, Turkey and Brazil) also granted emergency use authorization for this vaccine. In Turkey, on January 14, 2021, healthcare workers (HCWs) started to be vaccinated with CoronaVac as the priority group in vaccination. An important question that arose at this time was about how the vaccination schedule would be for people who had previously had Coronavirus disease 2019 (COVID-19). The Centers for Disease Control and Prevention (CDC) recommends that those who have had a previous COVID-19 infection can be vaccinated regardless of their previous infection. CDC guidelines also mention that "…if antibody (Ab) testing was done after the first dose of an mRNA vaccine, the vaccination series should be completed regardless of the Ab test result". It should be noted here that this statement applies particularly to mRNA type vaccines, whereas CoronaVac jab is an inactivated type two-dose regimen vaccine. The aim of this study was to present interim results of our ongoing study to compare the effect of two doses of inactivated CoronaVac vaccine on humoral immunity of people who had previously severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, and those people who did not have the infection. In our study, CoronaVac jab containing 600 SU inactivated SARS-CoV-2 antigen was administered as 0.5 ml to 62 HCWs in Yeditepe University Hospital (Istanbul, Turkey), in accordance with the manufacturer's recommendations. Ab levels against spike receptor binding region of SARS-CoV-2 were measured quantitatively. SARS-CoV-2 IgG assay were performed using Abbott Architect i2000 instrument (Abbott Laboratories, Abbott Park, IL, USA). Ab titers were measured before vaccination (Ab0), one month after the first vaccination (Ab1), and one month after the second vaccination (Ab2). The Ab responses of 62 HCWs before and after CoronaVac vaccination were determined. Two groups were created. Group 1 consisted of 18 females and 15 males who were tested as COVID-19 positive, previously. Group 2 consisted of 20 females and 9 males who never had the infection. Minimum, median and maximum Ab0 values of Group1 were 1.6, 180.8 and 5582.6, respectively and Ab1 values were 26.3, 1005.7 and 3923.1; Ab2 values were 202.1, 1119.1 and 2885.9, (in au/mL) respectively. On the other hand, minimum, median and maximum Ab0 values of Group 2 were 0.1, 1.8, and 37.2, Ab1 values were 4.7, 72.7, 470.2, and Ab2 values were 270.3, 746.2 and 5554.1, respectively. In Group 1, 20 of the HCWs showed lower Ab2 titers, while 13 of the HCWs showed higher Ab2 titers than the Ab1 titers. Whereas in Group2 all HCWs had higher Ab2 titers than the Ab1 titers. When the increasing and decreasing Ab2 titers of both groups were evaluated with the 2×2 contingency table and Fisher's exact chi-square test, a statistically significant difference was found between the groups (p<0.001). As a result, we think that a single dose of CoronaVac vaccine similarly to mRNA vaccines can be administered to people who have had COVID-19 due to the possibility that the Ab levels measured after the first dose of vaccine will decrease after the second dose of vaccine.

[Evaluation of a Visually-Read Rapid Antigen Test Kit (SGA V-Chek) for Detection of SARS-CoV-2 Virus]. / SARS-CoV-2 Virüs Tespitinde Görsel Okunan Hizli Antijen Test Kitinin (SGA V-Chek) Degerlendirilmesi.

Although the reverse transcriptase polymerase chain reaction (RT-PCR) method has been accepted as the reference method in the detection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) RNA, it requires special laboratory conditions, complicated and expensive laboratory instruments, competent laboratory staff and long testing duration. Antigen testing methods such as enzyme immunoassay, fluorescent antibody and visually-read immunochromatographic rapid antigen detection (RAD) tests eliminated the above mentioned disadvantages of the RT-PCR. The aim of this study was to determine the performance of a RAD test kit (V-Chek, SGA Ltd, Ankara, Turkey). Two paired nasopharyngeal swabs were collected from each patient, and one of them was used for the RAD test, while the other one (different swab) was used to perform the RT-PCR test. SARS CoV-2 Double Gene RT-PCR kit (Bioeksen, Turkey) was used for RNA amplification on the Light Cycler 480 plate-based RT-PCR instrument (Roche, Switzerland). The SARS-CoV-2 double gene RT-PCR kit targeting the SARS-CoV-2 specific N (nucleocapsid) and Orf1ab gene regions was used for RNA amplification. The human RNaseP gene was used for nucleic acid extraction and inhibition control. The shape of the growth curves was examined and the non-sigmoidal curves were recorded as "negative". Sigmoidal curves with cycle threshold (Ct) <38 were evaluated as "positive". The Ct values of all positive results were recorded. V-Chek RAD test kit uses a colloidal gold enhanced double antibody sandwich type antigen test kit. A SARS-CoV-2 positive specimen produces a distinct color band in the test region, formed by the specific antibody-antigen colored conjugate complex. A positive or negative result is indicated by a colored line appearance on the test region. A colored line appears in the control region, independent of the SARS-CoV-2 presence. The result is visually read 10 minutes after the last drop of the sample liquid is dispensed into the sample well. Specificity and sensitivity values were calculated accepting the RT-PCR results as a standard. Agreement between two different techniques was assessed using Cohen's kappa score. 110 patients were enrolled in this study; 34 (30.9 %) of these patients had positive RT-PCR samples, with the mean of Ct values of 25.8 (95% CI= 24.1-27.5), median of Ct values of 26. In our study population, the overall sensitivity was 61.8% (95% CI= 45.4-78.1), and specificity was 100%. Taking RT-PCR as reference, Cohen's kappa score for the antigen test was 0.691. Fisher's exact test was p<0.001. In conclusion, the RAD kit used in the study determined to be useful for the rapid identification of COVID-19 patients. However, a negative result does not eliminate the possibility of COVID-19 infection and should be confirmed by RT-PCR and clinical findings.

Haemostatic disorders in reproductive age women with menorrhagia and effects on quality of life.

The aim of this study was to determine the frequency of haemostatic abnormalities in women with menorrhagia and to evaluate their effect on quality of life (QoL). The study population was composed of patients with menorrhagia seen in the outpatient clinic, having a score of >185 with a pictorial blood assessment chart. Structured questionnaires were used in the assessment of demographic characteristics and QoL, and patients were tested for bleeding disorders. Ninety women were recruited for the study. Bleeding disorders were detected in 40% of them: 11.1% had von Willebrand disease, 2.2% had low von Willebrand factor and 26.7% had platelet function disorders (PFD). In 22 (91.6%) cases with PFD the, defect was non-specific and impaired aggregation response to ristocetine (37.5%) was the most commonly detected problem. Bleeding disorders were not associated with any significant reduction in QoL (p > .05). Hereditary bleeding disorders may be the cause of unexplained menorrhagia even in the middle-aged women, but they had no prominent effect on QoL.

Two rare diagnoses during chronic lymphocytic leukaemia follow-up: Kaposi's sarcoma and Merkel cell carcinoma.

Chronic lymphocytic leukaemia often has a clinical presentation characterised by increased neoplastic lymphocytes which are mostly mature looking due to B lymphocytes. Increased secondary cancer prevalence has been detected among patients with chronic lymphocytic leukaemia diagnosis. In this report, we present three chronic lymphocytic leukaemia patients who developed secondary rare cancers during their follow-up at our clinic. Case 1: A 54-year-old female patient was diagnosed with stage I chronic lymphocytic leukaemia in 2003 and was diagnosed with Merkel cell carcinoma in February 2013. Case 2: A 66-year-old male patient was diagnosed with stage II chronic lymphocytic leukaemia in 2009 and was diagnosed with Kaposi's sarcoma in March 2013. Case 3: A 77-year-old male patient was diagnosed with stage I chronic lymphocytic leukaemia in 2006 and was diagnosed with Kaposi's sarcoma in 2011. In conclusion, secondary cancers are observed in patients diagnosed with chronic lymphocytic leukaemia. Therefore, follow-up of chronic lymphocytic leukaemia requires additional attention in this context.

9,10-Dibromo-N-aryl-9,10-dihydro-9,10-[3,4]epipyrroloanthracene-12,14-diones: Synthesis and Investigation of Their Effects on Carbonic Anhydrase Isozymes I, II, IX, and XII.

N-substituted maleimides were synthesized from maleic anhydride and primary amines. 1,4-Dibromo-dibenzo[e,h]bicyclo-[2,2,2]octane-2,3-dicarboximide derivatives (4a-f) were prepared by the [4+2] cycloaddition reaction of dibromoanthracenes with the N-substituted maleimide derivatives. The carbonic anhydrase (CA, EC 4.2.1.1) inhibitory effects of the new derivatives were assayed against the human (h) isozymes hCA I, II, IX, and XII. All tested bicyclo dicarboximide derivatives exhibited excellent inhibitory effects in the nanomolar range, with Ki values in the range of 117.73-232.87 nM against hCA I and of 69.74-111.51 nM against hCA II, whereas they were low micromolar inhibitors against hCA IX and XII.

Does the preference of peripheral versus central venous access in peripheral blood stem cell collection/yield change stem cell kinetics in autologous stem cell transplantation?

Central venous access is often used during apheresis procedure in stem cell collection. The aim of the present study was to evaluate whether central or peripheral venous access has an effect on stem cell yield and the kinetics of the procedure and the product in patients undergoing ASCT after high dose therapy. A total of 327 patients were retrospectively reviewed. The use of peripheral venous access for stem cell yield was significantly more frequent in males compared to females (p = 0.005). Total volume of the product was significantly lower in central venous access group (p = 0.046). As being a less invasive procedure, peripheral venous access can be used for stem cell yield in eligible selected patients.

Subfoveal Choroidal Thickness Is Associated with Blood Hematocrit Level.

PURPOSE: To compare subfoveal choroidal thickness (SFCT), retinal vessel caliber, and ocular pulse amplitude between treated polycythemia vera (PV) patients and healthy adults. METHODS: Forty patients with PV and 40 age- and sex-matched healthy controls were recruited for this cross-sectional study. Spectral-domain optical coherence tomography was used for SFCT and retinal vessel caliber measurements. The Pascal dynamic contour tonometer was used for ocular pulse amplitude measurements. The correlations of blood hematocrit levels with the studied ocular parameters were analyzed. RESULTS: There were no statistically significant differences between the PV patients and controls in SFCT, retinal vessel caliber, and ocular pulse amplitude (p > 0.05). SFCT was associated with hematocrit level in both PV patients and healthy adults (p < 0.05). CONCLUSIONS: Although SFCT, retinal vessel caliber, and ocular pulse amplitude parameters are similar in treated PV patients and healthy controls, SFCT is associated with hematocrit level.

Successful Treatment of Refractory Gastrointestinal Bleeding by Systemic (Oral) Ankaferd Blood Stopper in a Patient with Glanzmann Thrombasthenia.

BACKGROUND: Glanzmann Thrombasthenia (GT) is a genetic platelet dysfunction and a life threatening disease. Ankaferd Blood Stopper (ABS) is a topical hemostatic agent of herbal origin which has been recently made available for clinical use. Its hemostatic effect is independent from blood clotting factors and occurs as a result of the aggregation of focal red blood cells by an encapsulated protein web. CASE REPORT: In this paper, a patient with GT is presented in whom 3 months of gastrointestinal bleeding refractory to all medical therapies was controlled within a short time of using oral ABS. CONCLUSION: The difference between this patient and other cases presented in the medical literature is the oral use of ABS. Thus, this patient may contribute to the medical community in showing the safety and efficacy of systemic (oral) ABS in patients with disorders of coagulation. However, there is a need for more patient experiences.

MYD88 expression and L265P mutation in mature B-cell non-Hodgkin lymphomas.

BACKGROUND: Myeloid differentiation primary response 88 (MYD88) is a common adaptor protein that is responsible for signaling from several receptors; mutations in this gene may play a role in the pathogenesis of lymphoma. AIM: We aimed to determine the MYD88 L265P mutation frequency, the level of MYD88 expression, and their associations with clinicopathological parameters in mature B-cell non-Hodgkin lymphomas (NHLs). METHODS: A total of 68 patients were included in the study. The presence of the MYD88 L265P mutation was analyzed by real-time polymerase chain reaction and direct sequencing. MYD88 protein expression was evaluated by immunohistochemistry (IHC) using two different scoring systems. RESULTS: MYD88 L265P mutation was present in eight (18.6%) diffuse large B-cell lymphoma (DLBCL) patients. We also observed a significant association between the loss of MYD88 expression and advanced stage in both mature B-cell NHL and DLBCL according to the first IHC scoring systems (p=0.015 and p=0.024, respectively). An association was also seen between MYD88 overexpression and low clinical risk in both mature B-cell NHL and DLBCL according to the second IHC scoring system (p=0.027 and p=0.024, respectively). CONCLUSIONS: The L265P mutation may be helpful for understanding the pathogenesis of immune-privileged site-associated DLBCLs. The presence of the mutation, together with its protein overexpression, could also be used as a prognostic marker in advanced stage DLBCLs.

Possible Role of GADD45γ Methylation in Diffuse Large B-Cell Lymphoma: Does It Affect the Progression and Tissue Involvement?

OBJECTIVE: Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma among adults and is characterized by heterogeneous clinical, immunophenotypic, and genetic features. Different mechanisms deregulating cell cycle and apoptosis play a role in the pathogenesis of DLBCL. Growth arrest DNA damage-inducible 45 (GADD45γ) is an important gene family involved in these mechanisms. The aims of this study are to determine the frequency of GADD45γ methylation, to evaluate the correlation between GADD45γ methylation and protein expression, and to investigate the relation between methylation status and clinicopathologic parameters in DLBCL tissues and reactive lymphoid node tissues from patients with reactive lymphoid hyperplasia. MATERIALS AND METHODS: Thirty-six tissue samples of DLBCL and 40 nonmalignant reactive lymphoid node tissues were analyzed in this study. Methylation-sensitive high-resolution melting analysis was used for the determination of GADD45γ methylation status. The GADD45γ protein expression was determined by immunohistochemistry. RESULTS: GADD45γ methylation was frequent (50.0%) in DLBCL. It was also significantly higher in advanced-stage tumors compared with early-stage (p=0.041). In contrast, unmethylated GADD45γ was associated with nodal involvement as the primary anatomical site (p=0.040). CONCLUSION: The results of this study show that, in contrast to solid tumors, the frequency of GADD45γ methylation is higher and this epigenetic alteration of GADD45γ may be associated with progression in DLBCL. In addition, nodal involvement is more likely to be present in patients with unmethylated GADD45γ.

N-Acylsulfonamides strongly inhibit human carbonic anhydrase isoenzymes I and II.

Sulfonamides represent a significant class of biologically active compounds that inhibit carbonic anhydrase (CA, EC.: 4.2.1.1) isoenzymes involved in different pathological and physiological events. Sulfonamide CA inhibitors are used therapeutically as diuretic, antiglaucoma, antiobesity and anticancer agents. A series of new sulfonamides were synthesized using imides and tosyl chloride as starting materials. These N-acylsulfonamides efficiently inhibited the cytosolic human carbonic anhydrase isoenzymes I, and II (hCA I, and II), with nanomolar range inhibition constants ranging between 36.4 ± 6.0-254.6 ± 18.0 and 58.3 ± 0.6-273.3 ± 2.5 nM, respectively.

Eltrombopag for the Treatment of Immune Thrombocytopenia: The Aegean Region of Turkey Experience.

OBJECTIVE: Immune thrombocytopenia (ITP) is an immune-mediated disease characterized by transient or persistent decrease of the platelet count to less than 100x109/L. Although it is included in a benign disease group, bleeding complications may be mortal. With a better understanding of the pathophysiology of the disease, thrombopoietin receptor agonists, which came into use in recent years, seem to be an effective option in the treatment of resistant cases. This study aimed to retrospectively assess the efficacy, long-term safety, and tolerability of eltrombopag in Turkish patients with chronic ITP in the Aegean region of Turkey. MATERIALS AND METHODS: Retrospective data of 40 patients with refractory ITP who were treated with eltrombopag in the Aegean region were examined and evaluated. RESULTS: The total rate of response was 87%, and the median duration of response defined as the number of the platelets being over 50x109/L was 19.5 (interquartile range: 5-60) days. In one patient, venous sinus thrombosis was observed with no other additional risk factors due to or related to thrombosis. Another patient with complete response and irregular follow-up for 12 months was lost due to sudden death as the result of probable acute myocardial infarction. CONCLUSION: Although the responses to eltrombopag were satisfactory, patients need to be monitored closely for overshooting platelet counts as well as thromboembolic events.

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.

The effect of gradual increment in rhG-CSF dose on stem cell yields in patients with multiple myeloma mobilized with intermediate dose cyclophosphamide plus rhG-CSF.

Cyclophosphamide along with recombinant human granulocyte-colony stimulating factor (rhG-CSF) is a commonly used strategy for mobilization. However, the optimal timing for rhG-CSF initiation after cyclophosphamide has not been determined as conclusively as has the G-CSF dose. In this paper, we aimed to present gradual dose increment of rhG-CSF between the third day of mobilization and time to apheresis that is started with 5 µg/kg (from day 3 to day 7) and continued with 10 µg/kg (from day 8 to time to apheresis) for peripheral blood stem cell (PBSC) mobilization in multiple myeloma (MM) patients and its effect on stem cell yield and mobilization success. Data from 30 consecutive patients with MM who underwent PBSC mobilization between October 2011 and June 2013, were retrospectively reviewed. While twenty-eight of 30 patients (93.3%) were successfully mobilized, 2 patients (6.7%) had mobilization failure. The final median CD34+ cell dose harvested from the patients was 9.5×10(6)/kg. The median number of apheresis was 2.5 (range, 0-3). Twenty-four patients (80%) yielded >2×10(6) CD34+ cells/kg in one apheresis procedure. In conclusion, our regimen might be used to decrease the mobilization failure regarding the low dose rhG-CSF use and provide a cost effective strategy.

Dramatic response in the dependency to transfusion after low doses of lenalidomide treatment in a 5q-syndrome patient: a case report.

5q-syndrome is a special subgroup of myelodysplastic syndrome in terms of follow-up and treatment. Lenalidomide is an immunomodulatory drug that is frequently used in the treatment of multiple myeloma. Some clinical studies have shown that lenalidomide treatment is effective in 5q syndrome and significantly decreases the transfusion dependency in these patients. In this paper, we would like to share a dramatic response of lowered transfusion dependency after treatment with low-dose lenalidomide in a patient who received myelodysplastic syndrome diagnosis and isolated 5q anomaly in our clinic.

Therapeutic plasma exchange in patients with neurological diseases: multicenter retrospective analysis.

Therapeutic plasma exchange (TPE), is a procedure, changing pathologic substances in the plasma of patients with replacement fluid. TPE has an increasing list of indications in recent years such as neurological, connective tissue, hematological, nephrological, endocrinological and metabolic disorders. We report our multicenter data about therapeutic plasma exchange in patients with neurological diseases. Six University Hospitals' aphaeresis units medical records about neurologic diseases were reviewed retrospectively. Hundred and fifteen patients and 771 TPE sessions from six aphaeresis units' were included to this study. Of the 115 patients, 53 (46%) were men and 62 (54%) were women. The median age was 50 (range: 5-85) years. Of these patients 58.3% were Guillain-Barre syndrome (GBS), 17.4% were acute disseminated encephalomyelitis (ADEM), 10.4% were chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), 7% were multiple sclerosis, 6.1% were myasthenia gravis (MG) and 0.9% were Wilson disease (WD). The median number of TPE sessions per patient was 5 (range 1-72). Human albumin was used as a replacement fluid in 66% and fresh frozen plasma was used in 34% of cases. TPE was done through central venous catheters in 66%, and peripheral venous access in 34% of patients. Some complications were seen in patients (18.3%) during TPE sessions. These complications were, complications related to catheter placement procedure (8.7%), hypotension (3.5%), hypocalcaemia (3.5%) and allergic reactions (1.7%). The complication ratios were 2.7% in total 771 TPE procedures. TPE procedure was terminated in 6% of sessions depending on these complications. Overall responses to TPE were noted in 89.5% of patients. In conclusion; Therapeutic plasma exchange is an effective treatment option in several neurologic diseases.