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Introduction. Skin manifestations are common in hematology ward patients and can result from infection, malignancy, or chemotherapy. The purpose of this study was to identify the most common dermatological problems encountered in the adult hematology ward at King Abdullah Specialist Children Hospital (KASCH). Methods. This was retrospective chart review of 78 dermatology consultations based on electronic health records for all inpatients in hematology wards at KASCH between January 2016 and December 2017. Data were presented as mean ± SD for continuous variables. Results. During the study period, a total of 1391 inpatients were referred to the dermatology department. A total of 403 (29.0%) referrals were from the internal medicine department and 78 (5.6%) were from the hematology department, six of which were rejected by the dermatology department. Almost all requests for referral were managed on the same or the next day with only two requests after 3 days. There were more female (n = 40; 51.3%) than male patients (n = 38; 48.7%) and the average age ± SD was 40.7 ± 19.8 years. Patients were diagnosed with a diverse range of hematological diseases. A total of 27 (35.1%) patients were diagnosed with acute myeloid leukemia. Overall, 98 differential diagnoses were made by dermatologists with only 26 being confirmed by skin biopsy. Eight (30.8%) patients were diagnosed with graft versus host disease confirmed by skin biopsy. The diagnoses were changed in 12 cases after skin biopsy. Several types of dermatitis were diagnosed in hematology ward patients including stasis dermatitis and contact dermatitis. The source of infection was not specified in most cases and the infection was treated empirically. Conclusion. Various dermatological disorders and cutaneous manifestations are observed in hematology inpatients with morbilliform drug eruption and graft versus host disease being the most common.
RESUMO
Thyroid function abnormalities are common in hemodialysis (HD) patients. Here, we investigated their frequency and impact on intradialytic hemodynamics and erythropoietin resistance index (ERI). Demographic and laboratory data including thyroid-stimulating hormone (TSH), interdialytic weight gain, and intradialytic blood pressure (BP) changes were measured, and ERI was calculated. The prevalence and causes of abnormities in TSH and free thyroxine (FT4) and their effects on ERI and intradialytic hemodynamics were then assessed. One hundred and thirty patients (mean age, 57.1 ± 19.2 years; 66.4% diabetic, 86.7% hypertensive) were enrolled. Among them, 16.7% had hypothyroidism, 2.3% had hyperthyroidism, and 10.9% had subclinical hypothyroidism. TSH level was significantly associated with higher BP (P <0.05), lower albumin (3.6 ± 4.4 and 2.6 ± 1.8, respectively; P = 0.05), lower dialysis hours (3.9 ± 5.3 and 2.6 ± 1.8, respectively), and lower ERI (3.7 ± 4.4 and 2.4 ± 1.9, respectively; P = 0.05). FT4 was significantly associated with higher interdialytic weight gain (13.4 ± 4.3 and 11.8 ± 2.2 pmol/L, respectively; P = 0.009) and higher pre-HD diastolic BP (13.2 ± 4.0 and 12.0 ± 2.9 pmol/L, respectively; P = 0.05). A negative correlation was seen between TSH level and urea reduction ratio (r = 0.29, P = 0.002), serum albumin (r = 0.304, P = 0.001), hemoglobin level (r = 0.26, P = 0.005), and ERI (r = 0.2, P = 0.002). A higher TSH level was associated with hypertension, lower albumin level, fewer dialysis hours, and increased resistance to erythropoietin. TSH level was negatively correlated with dialytic adequacy, serum albumin level, hemoglobin level, and ERI.