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    An evaluation of thrombocytopenia cases in the hematology clinic of the ankara numune training and research hospital
    (Wolters Kluwer Medknow Publications, 2022) Sarı, Öznur; N/A; Üre, Ümit Barbaros; Doctor; N/A; Koç University Hospital; N/A
    Background: Thrombocytopenia is a major disease that requires the referral of outpatient and hospitalized patients to hematology specialists. Objectives: The present study aims to evaluate the laboratory and transfusion statuses of adult patients admitted to our hospital and receiving outpatient/inpatient treatment and diagnosed with thrombocytopenia (< 100 x 109/l). Design: Single-center, retrospective, laboratory-based study. Patients and Methods: In the study, after obtaining permission of the hospital's Non-Invasive Clinical Research Ethics Committee, the information of patients diagnosed with thrombocytopenia (platelet count < 100 x 109/l) and who were examined and treated in the outpatient/inpatient settings between 2008 and 2010 were retrospectively analyzed using patient files and the hospital electronic database. Sample Size: A total of 1020 patients diagnosed with thrombocytopenia. Results: The patients were divided into groups according to the most common diagnoses for diseases associated with thrombocytopenia (hematological malignancy, disseminated intravascular coagulation (DIC)-sepsis, immune thrombocytopenia (ITP), infection, and chronic liver disease (n=708). Chemotherapy-induced, drug-induced, nutritional (B12, folate deficiency, etc.), OKIT, pregnancy-induced thrombocytopenias and other less common causes of thrombocytopenia were evaluated in a separate group (n=312). It was found that female patients were more frequently diagnosed with ITP (71.7 vs. 28.3%). Sex distributions were similar in other groups. The highest mean age (71 years: 50/80) was observed in patients with DIC-sepsis, whereas the lowest mean age was found in patients with ITP (40 years: 30/57) (P < 0.001). It was found that the most frequent need for transfusion developed in patients diagnosed with acute myeloid leukemia, acute lymphoblastic leukemia, and aplastic anemia. Conclusion: In this study, it was determined that the prevalence of thrombocytopenia was highest in patients diagnosed with hematological malignancy, ITP, and DIC-sepsis, respectively. In cases of hematological malignancy, the need for replacement of blood products is considered to be inevitable during the treatment process of the underlying disease compared with other clinical conditions.
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    PublicationOpen Access
    Evaluation of iron deposition in the adrenal glands of beta thalassemia major patients using 3-Tesla MRI
    (Kowsar Publishing Corporation, 2016) Güzelbey, Tevfik; Özveren, Olcay; Sarsılmaz, Ayşegül; Karasu, Ebru; N/A; N/A; Gürses, Bengi; Öztürk, Erman; Faculty Member; Doctor; School of Medicine
    Background: Beta-thalassemia major (beta-TM) patients need blood transfusions, which result in iron deposition. To regulate chelation therapy, iron load has to be measured. With MRI, the amount of signal loss and T2* decay time shortening are used for iron quantification. Objectives: The aim was to measure adrenal iron load with T2* relaxometry using MRI, and to compare it with liver and cardiac iron and serum ferritin, and to find out whether adrenal iron could be predicted from those parameters. Patients and Methods: Between October 2014 and March 2015, MRI was performed in 21 patients with beta-TM, recieving blood transfusions and chelation therapy. The control group (n = 11) included healthy volunteers with no known history of adrenal, hematologic, chronic disease, and blood transfusion. Results: Among patients, there was no significant correlation between plasma ferritin and adrenal T2*. Significant difference was detected among T2* values of adrenals between the patient and control groups. There was no significant correlation between adrenal gland and liver T2* in beta-TM patients, moderate correlation was detected between adrenal T2* and cardiac T2*. Conclusion: Adrenal iron in beta-TM can be reliably measured in 3 Tesla MRI. The results highlight the absence of correlation between adrenal iron deposition both with serum ferritin and hepatic iron.
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    PublicationOpen Access
    Iatrogenic hyperviscosity and thrombosis
    (Thieme Publishing, 2012) Meiselman, Herbert J.; Başkurt, Oğuz Kerim; Faculty Member; School of Medicine; 2389
    It is well known that hemostatic-thrombotic mechanisms are influenced by hemodynamic factors, such as shear forces affecting platelets or red blood cell aggregation, in turn affecting flow in stenotic regions. Endothelial cell function is also significantly influenced by shear forces acting on the vessel wall. Further, the distribution of shear forces in the vasculature is complex and closely associated with factors determining the flow properties of blood. Therefore, there is a link among alterations in the rheological properties of blood and its elements and the risk for thrombosis, with this linkage confirmed by numerous clinical studies. After discussing relevant rheological and hemodynamic concepts, this review focuses on selected drug-induced conditions that are known to be associated with both hyperviscosity conditions and increased thrombotic risk: oral contraceptives, diuretics, intravenous immunoglobulin, erythropoiesis-stimulating agents, chemotherapy, and radio-contrast media. Alterations of relationships between blood rheology and thrombotic risk related to artificial circulatory environments and physical exercise are also briefly discussed.
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    PublicationOpen Access
    Pesg PNH diagnosis, follow-up and treatment guidelines
    (e-Century Publishing Corporation, 2016) Şahin, Fahri; Ayer, Mesut; Dal, Mehmet Sinan; Ertop, Şehmus; İlhan, Osman; Karakuş, Volkan; Özcan, Mehmet Ali; Özkocaman, Vildan; Özsan, Hayri; Salim, Ozan; Tobu, Mahmut; Tombak, Anıl; Tuğlular, Tülin Fıratlı; Yılmaz, Mehmet; Ünal, Ali; Yenerel, Mustafa Nuri; Saydam, Güray; Akay, Olga Meltem; Faculty Member; Koç University Hospital; 170966
    PNH Education and Study Group (PESG) have been established in December 2013 as a non-profit, independent, medical organization www.pesg.org. Paroxysmal Nocturnal Hemoglobinuria (PNH) is a multi-systemic disease that should be treated with a multidisciplinary approach. Patients may apply to the clinics other than the hematology due to variability and diversity of clinical findings which lower the rate of diagnosis due to low awareness about PNH. PNH might be overlooked and diagnosis might be delayed. Regarding these, PESG was established with the collaboration of Immunology, Cardiology, Thorax Diseases (Pulmonology), Neurology, Gastroenterology, General Surgery and Urology specialists in addition to hematologists dealing with PNH. The PESG study group aims to increase the awareness about PNH, including training activities about PNH, strengthening the relations between clinics and planning of clinical studies as a goal. It is the first professional organization focusing on PNH, in Turkey.In this guideline, we want to facilitate the diagnosis attributes of physicians from all specializations that deal with PNH and its systemic complications. One can perceive this as a tailor made guideline of international guidelines but not a compilation.
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    Phosphoproteomic changes in red blood cell membranes by Adenylyl cyclase/Protein kinase A signaling pathway and their roles on the mechanical stress responses of red blood cells
    (Ios Press, 2021) N/A; N/A; N/A; N/A; Uğurel, Elif; Çilek, Neslihan; Göksel, Evrim; Yalçın, Özlem; Researcher; PhD Student; PhD Student; Faculty Member; School of Medicine; Graduate School of Health Sciences; Graduate School of Health Sciences; School of Medicine; N/A; N/A; N/A; 218440
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    PublicationOpen Access
    The double hazard of bleeding and thrombosis in hemostasis from a clinical point of view: a global assessment by rotational thromboelastometry (ROTEM)
    (Sage, 2018) N/A; Akay, Olga Meltem; Faculty Member; School of Medicine; 170966
    Hemostasis is a complex dynamic process involving bleeding and thrombosis as two end-points. Conventional coagulation tests which are measured in plasma examine only isolated portions of the coagulation cascade, thereby giving no information on important interactions essential to the clinical evaluation of hemostatic function. Thromboelastography (TEG), originally described in 1948 has improved over the decades and become a valuable tool of coagulation testing because of the limitations of standard coagulation tests. TEG is a technique that provides data about the entire coagulation system, from the beginning of clot formation to fibrinolysis, involving both cellular and plasma components of hemostasis. Rotational thromboelastometry (ROTEM) which evolved from TEG technology overcome several limitations of classical TEG while maintaining a good correlation with conventional TEG determination. ROTEM analyses are useful for rapid assessment of global clotting function in various clinical situations including liver transplantation, cardiac surgery, obstetrics, trauma, hemophilia and idiopathic thrombocytopenic purpura. ROTEM has been also reported to be useful in identifying various hypercoagulable conditions including major surgery, malignancy, Behcet's disease and apheresis. Further developments in ROTEM based transfusion strategies may also reduce transfusion requirements and improve clinical outcomes by optimizing the administration of blood components. This is a literature review of ROTEM including its technique, interpretation and specially clinical applications in different scenarios of bleeding and thrombotic disorders.