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1.
Expert Rev Hematol ; 14(2): 211-217, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33433245

RESUMO

Introduction: Chronic Myeloid leukemia (CML) is one of the first hematological malignancy linked with genetic alterations and have a targeted therapy with Tyrosine Kinase Inhibitors. However, there are certain unanswered questions and many unmet needs which limit its treatment. Concurrent Mycobacterium Tuberculosis (Mtb) infection is one of those significant factors. Tuberculosis (TB) is a highly prevalent disease in association with diabetes mellitus, malignancy, poor socioeconomic environment, HIV, and other immunosuppressive conditions in developed and developing countries. Anti-TB medications can affect other drug's pharmacokinetics by altering liver enzymes metabolism and poses treatment challenge with CML medications.Areas covered: The authors performed a rigorous literature review between 2000 and 2020 using PubMed and Google Scholar, with the main focus on all articles addressing the topic of TB in CML. Authors highlighted the need to improve clinical diagnosis and to define management strategy for this dilemma.Expert opinion: In the current era, there are no clear guidelines or recommendations in the literature that address this problem. The aim of this review was to collect and carefully analyze the literature to highlight the need for comprehensive guidelines and propose an algorithm for better management of TB in patients with CML.

2.
Artigo em Inglês | MEDLINE | ID: mdl-33495932

RESUMO

Endophytic fungi isolated from desert plants are among the less known organisms with potentially valuable applications. The bioactivities of an endophytic fungus isolated from Aloe vera, a plant found in central regions of Asir desert, Saudi Arabia. Based on primary phytochemical screening, an efficient isolate was selected and identified according to the sequence analysis of the internal spacer regions ITS1, ITS4 and the 5.8S region as Preussia africana belonging to the family Sporormiaceae. The crude extract of this fungus was evaluated for its bioactivities. Under static conditions, the crude extract at a concentration of 500 µg/mL had a strong 2,2-diphenyl-1-picrylhydrazyl (DPPH) scavenging rate of 87%, whereas a higher concentration (100 µg/mL) had an astounding wound healing effect (42.6% at 48 h) when compared to positive control. Moreover, the crude extract with a concentration of 50 µg/mL was active against almost all cancer cell lines such as HeLa (cervical cancer), Hep G2 (liver cancer), MCF-7 (breast cancer), A549 (lung cancer), LN-229 (glioblastoma), A-431 (skin cancer), and kidney cell line (HEK 293T). The results suggest that the endophytic fungus P. africana from A. vera has wide therapeutic applications against severe disease conditions.

3.
Cancer Control ; 27(1): 1073274820976594, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33297765

RESUMO

Hepatitis B reactivation (HBVr) in cancer patients is a well-established complication due to chemotherapy-induced immunosuppression. Studies have reported HBVr associated with immunosuppressive medications, such as rituximab, methotrexate, and high dose steroids. There are different risks for different types of chemotherapy with rituximab carrying one of the highest risks for hepatitis B reactivation. Tyrosine kinase inhibitors (TKIs) are the standard of care in patients with chronic myeloid leukemia (CML). The risk of HBVr in chronic myeloid leukemia has been reported in many studies, but to this date, there are no clear guidelines or recommendations regarding screening and monitoring of HBV in CML patients receiving TKIs. We conducted this review to identify the risk of HBVr in patients with CML who are treated with tyrosine kinase inhibitors. We recommend testing for HBV status in patients who are to be treated with TKIs and to consider giving prophylaxis in those who are positive for HBsAg at baseline. More studies are needed to assess the risk of reactivation in patients with Hepatitis B core antibody positive receiving TKIs. Currently, monitoring such patients for reactivation may be the best strategy.

5.
Medicine (Baltimore) ; 99(51): e23637, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371098

RESUMO

ABSTRACT: The main aim of this study is to compare the 2 medications denosumab and zoledronic acid for patients with beta-thalassemia major induced osteoporosis. Patients with B-thalassemia major induced osteoporosis will undergo baseline assessment of the bone densitometry by bone density(DEXA) scan as a standard of care by the radiology department, then a blood test for bone-specific alkaline phosphatase and type-1 collagen telopeptide will be measured by the chemistry laboratory.Patients with B-thalassemia major induced osteoporosis, who are 18 years of age or more and willing to participate in the study will be enrolled after consenting by the primary investigator in hematology outpatient clinics. Patients with osteoporosis will receive 1 of the 2 medications; at the end of the year, DEXA scan will be done to compare the response of the 2 medications. The potential risks include drug-related side effects.The outcome will be measured biochemically by measuring bone-specific alkaline phosphatase and type 1 collagen carboxy telopeptide and radiologically by DEXA scan at baseline and 1 year using Z score.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Denosumab/uso terapêutico , Osteoporose/tratamento farmacológico , Ácido Zoledrônico/uso terapêutico , Talassemia beta/complicações , Ensaios Clínicos Fase III como Assunto , Humanos , Osteoporose/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
Clin Case Rep ; 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-33362923

RESUMO

Due to the overlap between ACS and COVID-19 pneumonia, we recommend close monitoring for those patients and offering them RBC exchange early in the course of the disease to avoid clinical deterioration.

7.
Medicine (Baltimore) ; 99(45): e23088, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157979

RESUMO

The objectives of this research project are to study in patients with primary myelofibrosis (PMF) and Essential Thrombocythemia (ET); (1) the uptake patterns of FLT-PET (FLT-PET) and its value in diagnosing, staging, and treatment response monitoring of malignant hematopoiesis, (2) compare imaging findings from FLT-PET with bone marrow biopsy (standard of care), and (3) associate FLT-PET uptake patterns with genetic makeup such as JAK2 (Janus kinase 2), CALR (Calreticulin), MPL (myeloproliferative leukemia protein), Triple negative disease, and allele burden.This trial is registered in ClinicalTrials.gov with number NCT03116542. Protocol version: Mar 2017.


Assuntos
Didesoxinucleosídeos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Mielofibrose Primária/diagnóstico por imagem , Trombocitemia Essencial/diagnóstico por imagem , Ensaios Clínicos Fase I como Assunto , Humanos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos
8.
Case Rep Oncol ; 13(3): 1215-1226, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33173488

RESUMO

Lymphomas are presently categorized according to their origin from B or T lymphocytes. The co-expression of CD3 in B-cell lymphomas or CD20 in T-cell lymphomas has been rarely reported. Immature and less often mature lymphomas may incorporate the rearrangements of both B- and T-cell antigen receptor genes (dual genotype or bigenotype). Lymphoma cells with a sole genotype hardly concurrently express both B- and T-cell markers (biphenotypic lymphomas). We describe a 63-year-old female who was presented with obstructive jaundice and epigastric pain of 10 days. Initial CBC revealed 43×103/µL white blood cells, 11.2 g/dL hemoglobin, and 88x103/µL platelets. CT abdomen revealed hepatomegaly and suspected pancreatic mass with large retroperitoneal lymph nodal mass. Peripheral smear showed 56% lymphoid cells with blast morphology. The bone marrow (BM) aspirate smear was infiltrated by 83% immature-looking cells. BM biopsy showed interstitial to diffuse extensive infiltration by primitive-looking cells, positive for pan-B-cell antigens CD20, CD79, and PAX5 as well as the T-cell antigen CD4, CD5, CD3, while negative for all immaturity markers (CD34, TdT, and CD1a). In situ hybridization for Epstein-Barr virus (EBV)-encoded small RNA (EBER) was negative. Flow cytometry on BM aspirate showed an abnormal population (50%) expressing the B-cell antigens (CD19, CD20, CD79, CD22) and CD10, and showed lambda light chain restriction as well as the T-cell antigens cCD3 and CD4 with partial CD5. The analysis showed, also, another abnormal population of lambda restricted monotypic B cells (8%) with dimmer CD45 (blast gate) and showed the same immunophenotype (expressing the B-cell antigens), but negative for CD10, cCD3, CD5, and CD4. Conventional cytogenetic revealed complex karyotype. Molecular studies revealed rearrangements of the immunoglobulin heavy chain region consistent with a clonal B-cell population. TCR gene rearrangement analysis was equivocal concerning clonality but was not conclusive for clonal T-cell disease. Our final diagnosis was peripheral blood and BM involvement by EBV-negative high-grade lymphoid neoplasm (in leukemic phase with blast morphology) and an ambiguous immunophenotype with a differential diagnosis that may include the rare entity of bigenotypic lymphoma or an unusual case of high-grade B-cell lymphoma with aberrant expression of T-cell markers (biphenotypic lymphomas).

9.
Adv Med Educ Pract ; 11: 843-850, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33192117

RESUMO

Purpose: The aim of this study was to evaluate the rate of internal medicine residents' and faculties' (specialists and consultants) compliance to colorectal cancer screening in Hamad Medical Corporation (Doha, Qatar) and to identify barriers as well as facilitators that will assist in drawing up changes that would enhance physician-related cancer screening. Methods: A cross-sectional web-based survey was distributed among internal medicine physicians at three component hospitals of Hamad Medical Corporation (HMC); focusing on knowledge and practice of colorectal cancer screening, its barriers and facilitators. Chi-square and t-test statistics were used to draw conclusions where appropriate. Results: The response rate for the survey was 91% and over 75% of the survey respondents were post-graduate trainees. The majority (90.6%) of the physicians (n=144) mentioned that they would recommend colorectal cancer screening for their asymptomatic patients, though trainees tend to choose the correct modality of screening compared to the consultants, 86.21% vs 40.74%. Only 43.4% of the survey participants always to usually recommend screening to their patients in their clinics while only 29.4% do so for their inpatients. Even though there was no statistically significant difference among the frequency of outpatient colorectal cancer screening among trainees, specialists or consultants (p=0.628), there was a clear increase in the reported referrals as the training years or the years of experience increases (p=0.049 for trainees and p=0.009 for faculty). Unclear pathway was reported as the main obstacle to outpatient cancer screening by 30.2% (n= 48) and 54% (n=87) pointed out that an easy and clear pathway for cancer screening would facilitate the same. Conclusion: While the attitude towards colorectal cancer screening is positive, the actual practice of recommendation is sub-optimal. Further initiatives are required to facilitate awareness and compliance to colorectal cancer screening.

10.
Case Rep Oncol ; 13(3): 1325-1329, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33250749

RESUMO

Selective immunoglobulin A (IgA) deficiency is one of many congenital immunodeficiencies. It is associated with several medical condition. It has been shown to be associated with some types of malignancies, some autoimmune disorders, and even with some infections. Here we report a young male with selective IgA deficiency who also tested positive for Helicobacter pylori and strongyloidiasis at the time when he was diagnosed with stomach adenocarcinoma. The presence of IgA deficiency with multiple etiological possibilities such as infections and cancer makes this case unusual.

11.
Cureus ; 12(9): e10305, 2020 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-33052268

RESUMO

Idiopathic thrombocytopenic purpura (ITP) is a disease in which the immune system attacks platelets and decreases their number, which increases the patient's risk of bleeding. ITP is diagnosed by exclusion and usually manifests as acute disease. It is self-limiting in pediatric patients, while it tends to be a chronic disease in adults. Treatment of ITP focuses on maintaining a sufficient platelet count to decrease the risk of bleeding rather than normalize the platelet count. Most patients respond to first-line treatments, such as steroids and intravenous immunoglobulin (IVIG). However, some cases can become steroid-dependent or unresponsive to first-line therapy, in which case, second-line therapy is required to control symptoms or the platelet count. Second-line therapy includes either rituximab or a thrombopoietin receptor agonist (eltrombopag, romiplostim). In a few cases, when second-line therapy alone is insufficient to control the disease, a combination of therapies is required to control the symptoms and platelet count. Here, we present a case of a 41-year-old man with refractory ITP who did not respond to first-line treatment with either steroids or IVIG or a combination of the two, and also did not respond to eltrombopag alone and required a combination of eltrombopag and rituximab to control his disease.

12.
Cureus ; 12(9): e10332, 2020 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-33052293

RESUMO

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease, with multisystemic involvement. Hemoglobin E/beta-thalassemia (HbE/beta-thalassemia) is the genotype responsible for approximately one-half of all severe beta-thalassemia worldwide. When beta-thalassemia and SLE coexist, SLE seems to have a more severe course. Here we report a 32-year-old female who presented with dizziness and fatigue was found to have severe hemolytic anemia with thrombocytopenia. Upon further evaluation, she was diagnosed with HbE/beta-thalassemia and SLE, which is a very rare association. In SLE patients, anemia usually results from the disease itself, but it is important to think of other coexisting conditions like thalassemia.

13.
Am J Case Rep ; 21: e926062, 2020 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-33098641

RESUMO

BACKGROUND COVID-19 is a newly emerging disease that is not yet fully understood. It is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel virus that is easily transmitted from human to human through the respiratory route. Usually, it presents with fever, headache, fatigue accompanied by respiratory symptoms like cough and dyspnea, and other systemic involvements. Chronic lymphocytic leukemia (CLL) is a common lymphoproliferative neoplasm characterized by absolute lymphocytosis and demonstration of clonality unlike other causes of lymphocytosis. Patients with CLL are considered immunocompromised because of impaired humoral immunity (mainly) and cellular immunity. Therefore, they are vulnerable to various infections including COVID-19. Little is known about the COVID-19 infection when it unmasks CLL. CASE REPORT A 49-year-old man with no significant previous illnesses, and an unremarkable family history, presented with a moderate COVID-19 infection. He initially presented to the emergency department with fever and mild shortness of breath. A complete blood count showed a high white blood cell count with absolute lymphocytosis. Flow cytometry revealed the clonality of the lymphocytes confirming the diagnosis of CLL. Despite having CLL, he developed a moderate COVID-19 infection and recovered in a few days. To the best of our knowledge, this is the first report of CLL, which presented with a COVID-19 infection as the initial presentation. CONCLUSIONS Lymphocytosis is an unexpected finding in patients diagnosed with COVID-19 infection and the elevated lymphocytes may be indicative of other conditions. Secondary causes of lymphocytosis like malignancy or other infections should be considered in these cases.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Hospedeiro Imunocomprometido , Leucemia Linfocítica Crônica de Células B/epidemiologia , Pneumonia Viral/epidemiologia , Comorbidade , Humanos , Leucemia Linfocítica Crônica de Células B/diagnóstico , Masculino , Pessoa de Meia-Idade , Pandemias
14.
Cureus ; 12(9): e10201, 2020 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-33042656

RESUMO

Anemia constitutes a major global health burden, and iron deficiency is the most common cause of it. Iron deficiency and replacement affect not only hemoglobin (Hb) levels but also other hematological parameters such as platelet count. In this mini-review, we explore thrombocytopenia as a side effect of iron replacement therapy. We searched for relevant articles published in English, and all case reports/series of iron-induced thrombocytopenia were collected and analyzed. A total of 11 case reports and one case series were found relating to very low Hb at a baseline level of 5.25 +/- 2.2 g/dl and variable platelet count at baseline that dropped in 9 +/-3 days to an average of 121 +/- 112 x 109/L, which in most of the cases was self-corrected. The parenteral route was more commonly reported to be associated with thrombocytopenia, and discontinuation of therapy was needed in two patients. The mechanisms, prevalence, and clinical significance of thrombocytopenia associated with iron replacement are unknown; several effects of iron on the primary hematopoietic cells and stromal cell lines have been proposed, such as influence on common progenitors, effects on cytokines, and thrombopoietic effect of erythropoietin, which is directly affected by iron levels. Iron replacement can lead to significant thrombocytopenia. Further research is needed to describe the exact incidence, mechanism, and clinical significance of thrombocytopenia associated with iron supplementation.

15.
Cureus ; 12(9): e10277, 2020 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-33042713

RESUMO

Chronic myeloid leukemia (CML) is one of the myeloproliferative neoplasms whose incidence peaks in older individuals and is characterized by the uncontrolled proliferation of cells in the myeloid cell line. It can present with symptoms related to leukocytosis or splenomegaly, and it can also be asymptomatic and found incidentally. Nilotinib is a second-generation tyrosine kinase inhibitor used in the treatment of the chronic phase of CML and was found to cause diabetes mellitus among other adverse effects. These adverse effects seem to occur after a few months to a few years of drug administration. Type-two diabetes is the most common type of diabetes; its hallmark being insulin resistance with resultant hyperglycemia. Most often, it has no symptoms and is usually found as an incidental finding or on screening. Here we present a 45-year old Chinese female, who was diagnosed with CML chronic phase after an incidental finding of leukocytosis; treated with nilotinib as upfront for CML, and developed diabetes mellitus after about one and a half years of treatment, which was treated with metformin.

16.
Cureus ; 12(7): e9413, 2020 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-32864242

RESUMO

Sickle cell anemia (SCA) is a hereditary hemoglobin (Hb) disorder associated with a very specific molecular lesion, which is the exchange of glutamic acid for valine in the sixth residue of the Hb beta chain, originating the S Hb. It is characterized by intermittent episodes of vascular occlusion and end-organ damage. Progressive organ damage may affect any organ with brain, eyes, pulmonary, hepatobiliary, spleen, genitourinary, and the musculoskeletal systems being the most commonly involved and reported. Other complications of the disease that have not been well described or studied include cranio-orbital syndromes, oropharyngeal syndromes, periodontal disease, and otologic syndromes. Considering the vaso-occlusive nature of sickle cell disease (SCD), the potential for auditory damage is not unexpected. However, the incidence of subjective hearing impairment among SCA is very low and and little is known about the relationship between SCA and hearing loss. Here we report a 43-year-old female with SCA who presented with sudden bilateral hearing loss and generalized body ache and admitted as a case of sensorineural deafness with vascular crisis; she received IV fluid and analgesia and improved after five days from the therapy.

17.
Acta Biomed ; 91(3): e2020010, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32921708

RESUMO

BACKGROUND: There is a scarcity of data regarding the effect of Type 2 diabetes mellitus (T2DM) and associated comorbidities on the clinical presentation and outcome of symptomatic patients with -COVID-19 infection in comparison with non-diabetic patients. AIM OF THE STUDY: We described and compared the clinical presentation and radiological and hematological data of a cohort of symptomatic COVID19 positive T2DM diabetic patients (n = 59) versus another cohort of non-diabetic symptomatic COVID19 positive patients (n =244) diagnosed at the same time from January 2020 to May 2020. Associated comorbidities were -assessed, and the Charlson Comorbidity Index was calculated. The outcomes including duration of hospitalization, duration of Intensive Care Unit (ICU) stay, duration of mechanical ventilation, and duration of O2 -supplementation were assessed. RESULTS: Prevalence of T2DM in symptomatic COVID19 positive patients was 59/303 (=19.5%).  Diabetic patients had higher prevalence of hypertension, chronic kidney disease (CKD) and cardiac dysfunction [coronary heart disease (CHD)], and congestive heart failure (CHF). Charlson Comorbidity score was significantly higher in the T2DM patients (2.4± 1.6) versus the non-diabetic -patients (0.28 ± 0.8; p: < 0.001). Clinically and radiologically, T2DM patients had significantly higher percentage of pneumonia, severe pneumonia and ARDS versus the non-diabetic patients. Hematologically, diabetic patients had significantly higher C-reactive protein (CRP), higher absolute neutrophilic count (ANC) and lower counts of lymphocytes and eosinophils compared to non-diabetic patients. They had significantly higher systolic and diastolic blood pressures, longer duration of hospitalization, ICU stay, mechanical ventilation and oxygen therapy. CRP was correlated significantly with the duration of stay in the ICU and the duration for oxygen supplementation (r = 0.37 and 0.42 respectively; p: <0.01). CONCLUSIONS: T2DM patients showed higher inflammatory response to COVID 19 with higher absolute neutrophilic count (ANC) and CRP with lower lymphocytic and eosinophilic counts. Diabetic patients had more comorbidities and more aggressive course of the disease with higher rate of ICU admission and longer need for hospitalization and oxygen use.


Assuntos
Betacoronavirus , Proteína C-Reativa/metabolismo , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Unidades de Terapia Intensiva , Pandemias , Pneumonia Viral/epidemiologia , Adulto , Biomarcadores/sangue , Comorbidade , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Seguimentos , Hospitalização/tendências , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/sangue , Pneumonia Viral/diagnóstico , Prevalência , Catar/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença
18.
Acta Biomed ; 91(3): e2020026, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32921722

RESUMO

A review of the literature on COVID-19 pandemic in patients with thalassemias is presented. Globally, the prevalence of COVID-19 among  ß-thalassemia patients seems to be lower than in general population; associated co-morbidities aggravated the severity of  COVID- 19, leading to a poorer prognosis, irrespective of age. A multicenter registry will enhance the understanding of COVID-19 in these patients and will lead to more evidence-based management recommendations.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Talassemia/epidemiologia , Comorbidade , Saúde Global , Humanos , Prevalência
19.
Case Rep Oncol ; 13(2): 793-797, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32884520

RESUMO

Iron deficiency anemia is the most common type of anemia, and it occurs when the human body does not have enough of the mineral iron (https://www.healthline.com/health/iron-deficiency-anemia#diagnosis). Iron deficiency anemia is caused by blood loss, insufficient dietary intake, or poor absorption of iron from food. Sources of blood loss can include heavy periods, childbirth, uterine fibroids, stomach ulcers, colon cancer, and urinary tract bleeding (https://www.nhlbi.nih.gov/health-topics/iron-deficiency-anemia). Poor absorption of iron from food may occur as a result of an intestinal disorder such as inflammatory bowel disease or celiac disease, or surgery such as a gastric bypass (https://www.who.int/nutrition/topics/ida/en/). Little is known about the association between iron deficiency anemia and lymphocytopenia. Here, we report on a 17-year-old female who presented with iron deficiency anemia and was found to have lymphopenia. She recovered after having received intravenous iron therapy.

20.
Case Rep Oncol ; 13(2): 863-866, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32884532

RESUMO

Off-label drug use refers to drug use beyond the specifications authorized for marketing [J Med Case Rep. 2014 Dec;8(1):303]. Eltrombopag is a thrombopoietin receptor agonist that has been used in treating thrombocytopenia due to chronic liver disease (CLD) as an off-label medication. Treatment of thrombocytopenia in patients with CLD constitute a real dilemma as the options are limited and some of them are invasive. However, thrombopoietin receptor agonist has been increasingly used for this purpose. Here we report a 34-year-old woman who has been diagnosed with CLD due to autoimmune hepatitis 20 years ago. Her condition was complicated with portal vein thrombosis, chronic thrombocytopenia, and variceal hemorrhage, and she has been listed as a candidate for liver transplantation. Given her high risk of bleeding, we started her on low dose of eltrombopag (25 mg daily) in order to maintain a platelet level of ≥50 × 103/µL. However, 1 year after initiation of the therapy, she developed left lower limb deep vein thrombosis.

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