A 58-year-old male with a history of alcoholic liver cirrhosis, hypertension and peptic ulcer was admitted to the local hospital in August 2016. He complained of easy fatigue and significant weight loss (>10 kg within the previous six months). On physical examination, hepatosplenomegaly and ascites were observed. Complete blood count (CBC) showed moderate anemia [hemoglobin (Hb) = 10 g/dL] and thrombocytopenia [platelets (PLT) = 46 × 10 9 /L]. Leukocyte count was elevated with monocytosis (1.76 × 10 9 /L) and eosinophilia (6.5 × 10 9 /L). Magnetic resonance imaging (MRI) confirmed the presence of ascites and hepatosplenomegaly (liver 175 mm, spleen 155 mm). The patient was referred to the Hematology Unit. On admission in September 2016, the blood film was in line with the previous findings. Bone marrow aspirate was normal except for eosinophilia. The BCR-ABL and FIP1L1-PDGFRA gene rearrangements were not detected, and karyotype was diploid on conventional cytogenetics. The patient was diagnosed with idiopathic hypereosinophilic syndrome and prescribed prednisone. As a result, blood eosinophilia normalized and platelet count increased to 140 × 10 9 /L, but monocytosis persisted. He remained stable for four years. In April 2021, platelet count dropped to 60 × 10 9 /L despite continued steroid treatment. Abdominal ultrasound and computed tomography (CT) scan detected splenomegaly, retroperitoneal lymphadenopathy, and fractures of the thoracic vertebrae. The patient was admitted to our Department in August 2021. He was thrombocytopenic (PLT = 52 × 10 9 / /L) and blood monocytosis was as high as 1.69 × 10 9 /L. Eosinophilia was not present. On biochemistry, bilirubin concentration was slightly increased to 29.1 µmol/L (N: 3.42-20.6), while alkaline phosphatase (AP) was normal. Trephine biopsy showed the presence of

Acquired hemophilia A (AHA) is a rare bleeding disorder, caused by the development of autoantibodies (inhibitor) against endogenous clotting factor VIII (FVIII). A common clinical manifestation is subcutaneous bleeding, but soft tissue hematomas and excessive post-operative hemorrhages may also occur. A diagnosis of AHA is made in patients presenting with an isolated prolonged activated partial thromboplastin time without correction in a mixed plasma study, and decreased FVIII activity. Multiple myeloma (MM) is a hematological malignancy of terminally differentiated plasma cells producing monoclonal protein (M protein). Although malignancy is found as an underlying disorder in 6–18% of AHA cases, MM seems to be a very rare cause of AHA. MM is associated with an increased risk of thrombotic complications, while AHA leads to bleeding in up to 95% of cases (although one third of patients do not require hemostatic treatment) and therefore management of patients with concomitant AHA and MM is a clinical challenge. For bleeding control and therapy of AHA, the by-passing agents activated prothrombin complex concentrate and recombinant activated factor VII, as well as porcine recombinant factor VIII, are efficient. However, for inhibitor eradication, immunosuppressive treatment can beinsufficient, and therefore intensive myeloma-aimed treatment is required. Disease- and therapy-related coagulation alterations in MM patients carry the risk of both thrombosis and bleeding, complicating the treatment of AHA in this group of patients.

Introduction: Coagulopathies are rare side effects with psychotropics and are thus frequently overlooked while prescribing. Selective serotonin reuptake inhibitors are more commonly associated with deranged bleeding parameters, the most frequent being decreased platelet aggregability and activity, and the prolongation of bleeding time. Thrombocytopenia as a side effect of valproate administration often goes unnoticed, and olanzapine has been associated with a higher risk of venous thromboembolism. The aim of our study was to determine what percentage of patients on psychotropics develop changes in bleeding parameters, and whether these changes are significant enough to warrant routine monitoring of these parameters. Material and methods: This was a prospective observational, single-center study which included 100 patients newly started on psychotropics. Those on medications affecting bleeding parameters or having an acute illness like sepsis were excluded. Patients were only on a single psychotropic agent, and their bleeding parameters — prothrombin time, international normalized ratio (INR), bleeding time, clotting time (CT) and platelet count — were assessed at baseline and after 15 and 30 days. Results: Mean values of prothrombin time (PT), INR, bleeding time and CT increased over time while the mean value of platelet count showed a decreasing trend but no clinical manifestations were noted. Olanzapine was the only drug causing a reduction of PT, INR and CT and valproate was the only drug affecting platelet count. Paroxetine affected the bleeding parameters the most among the antidepressants. Sertraline, fluoxetine, amitriptyline and haloperidol were the other drugs affecting various bleeding parameters, though the effects were less compared to the other drugs in the study. Conclusions: Routine monitoring of bleeding parameters in patients receiving psychotropics is not warranted, but caution must be taken while prescribing these drugs, especially in groups such as patients with known blood dyscrasias or peri-operative patients.

Introduction: Due to the high cost of targeted therapy, chemoimmunotherapy regimens remain the standard therapy for chronic lymphocytic leukemia in many developing countries. In this study, we compare the treatment outcomes of the two main chemoimmunotherapeutic regimens. Material and methods: Data was obtained from the oncology department archives at Tishreen University Hospital between 2016 and 2020. We enrolled previously untreated, fit patients with chronic lymphocytic leukemia who were treated with one of two regimens: either a fludarabine, cyclophosphamide, and rituximab regimen, or a bendamustine and rituximab regimen. Results: 78 patients were enrolled in the study. 56.8% of the fludarabine, cyclophosphamide, and rituximab group achieved complete response versus 73.5% of the bendamustine and rituximab group. Progression-free survival was slightly shorter for fludarabine, cyclophosphamide, and rituximab than for bendamustine and rituximab [median 15.1 months [95% confidence interval {CI} 12.4–17.8] vs. 17.7 months (95% CI 15.4–20.1)] without statistical significance. In elderly patients (>65 years) median progression-free survival (PFS) was significantly ( p = 0.046) longer with the bendamustine and rituximab treatment [median 19.9 months (95% CI 17.2–22.5)] than with the fludarabine, cyclophosphamide, and rituximab [median 11.6 months (6–17.2)]. Regarding overall survival, no significant difference between the two groups was documented. Delay and deletion of cycles, neutropenia and anemia were more frequent with the fludarabine, cyclophosphamide, and rituximab group. Furthermore, we found that elevated lactate dehydrogenase, positive expression of ZAP-70, stage C, and splenomegaly are all indicators of poor prognosis in correlation with PFS. Conclusions: Our study found that the bendamustine and rituximab regimen is safer than, and has comparable efficacy to, the standard therapy of fludarabine, cyclophosphamide, and rituximab for previously untreated, fit patients with chronic lymphocytic leukemia.

Introduction: As more data is collected, hematologists will be able to gain more insight into the impact of coronavirus disease 2019 (COVID-19) on pediatric patients with hematological malignancies. Material and methods: We analysed 21 cases of COVID-19 in pediatric patients with onco-hematological diseases treated in the Western Ukrainian Pediatric Medical Center from March 2020 through May 2021. The majority of patients (71.4%) were diagnosed with acute lymphoblastic leukemia. All patients from the analyzed cohort had an asymptomatic, mild or moderate course of coronavirus-19 infection. The most common symptoms of COVID-19 were fever, cough, gastrointestinal symptoms, and dermatitis. Severe severe acute respiratory syndrome coronavirus 2 increased the risk of liver toxicity and venous thrombosis. Results and conclusion: Our analysis showed that pediatric patients with hematological malignancies need the same treatment approach for COVID-19 as for other infective complications.