Usefullness of Baseline Neutrophil to Lymphocyte Ratio (NLR) in Hematological Malignancies

Systemic inflammatory response was reported to be a poor prognostic factor in several malignancies. An inexpensive and readily available laboratory tool, neutrophil to lymphocyte ratio (NLR), can be easily obtained from differential blood counts. Current evidence suggests that a baseline NLR may predict the long-term survival results of patients with lymphoproliferative diseases (especially diffuse large B-cell lymphoma). The relationship between systemic inflammation and cancer, and the usefulness of NLR in hematological malignancies will be disscussed in this comprehensive review

Deep Hypoalbuminemia in Patients with Immunoglobulin Light Chain Amyloidosis: A Risk Factor for Vascular Thromboembolic Events or Only a Causal Link?

Letter to Edito

The Effect of Iron Deficiency Anemia Treatment on Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio

Background: Both neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are cost-effective and readily available biomarkers. An increment in either NLR or PLR is an indicative of a prolonged chronic inflammatory condition and increased host inflammatory response. Iron deficiency anemia (IDA) is frequently associated in chronic disorders. Aims: We decided to investigate whether the efficient treatment of IDA should affect NLR and/or PLR values in an adult population with IDA. Methods: This was a retrospective (case-series) observational study conducted at an adult Hematology clinic in Turkey. Patients were ? 18 years-old, with IDA defined according to the World Health Organisation criteria. The hematological parameters, NLR, and PLR levels were noted before and after oral iron (Fe+2) repletion treatment. Results: A total of 200 patients with IDA (median age 44 years, IQR 32-52 years, women 91%) were included. NLR values did not differ significantly in terms of IDA treatment (2.07 vs. 2.01, p= .558). PLR levels were significantly decreased after IDA treatment (170.63 vs. 140.32, p< .001). The NLR and PLR were positively correlated (p= .01). A low-unremarkable inverse correlation between NLR, and serum iron levels (p= .024) and Tfsat (p= .038) was observed; a similar negative correlation was also observed between PLR, and serum iron (p= .002) and Tfsat (p= .013) levels. Conclusion: The treatment of IDA did not affect NLR, whereas it was associated with significant decrease in PLR. The NLR and PLR were positively correlated. However, both the NLR and PLR were inversely correlated with serum iron and Tfsat levels

Neurovascular relationship between abducens nerve and anterior inferior cerebellar artery

We aimed to study the neurovascular relationships between the anterior inferior cerebellar artery (AICA) and the abducens nerve to help determine the pathogenesis of abducens nerve palsy which can be caused by arterial compression. Twenty-two cadaveric brains (44 hemispheres) were investigated after injected of coloured latex in to the arterial system. The anterior inferior cerebellar artery originated as a single branch in 75%, duplicate in 22.7%, and triplicate in 2.3% of the hemispheres. Abducens nerves were located between the AICAs in all hemispheres when the AICA duplicated or triplicated. Additionally, we noted that the AICA or its main branches pierced the abducens nerve in five hemispheres (11.4%). The anatomy of the AICA and its relationship with the abducens nerve is very important for diagnosis and treatment

Morphologic Mapping of the Sublingual Microcirculation in Healthy Volunteers

PURPOSE Monitoring the sublingual and oral microcirculation (SM-OM) using hand-held vital microscopes (HVMs) has provided valuable insight into the (patho)physiology of diseases. However, the microvascular anatomy in a healthy population has not been adequately described yet. METHODS Incident dark field-based HVM imaging was used to visualize the SM-OM. First, the SM was divided into four different fields; Field-a (between incisors-lingua), Field-b (between the canine-first premolar-lingua), Field-c (between the first-second premolar-lingua), Field-d (between the second molar-wisdom teeth-lingua). Second, we investigated the buccal area, lower and upper lip. Total/functional vessel density (TVD/FCD), focus depth (FD), small vessel mean diameters (SVMDs), and capillary tortuosity score (CTS) were compared between the areas. RESULTS Fifteen volunteers with a mean age of 29 ± 6 years were enrolled. No statistical difference was found between the sublingual fields in terms of TVD (p = 0.30), FCD (p = 0.38), and FD (p = 0.09). SVMD was similar in Field-a, Field-b, and Field-c (p = 0.20-0.30), and larger in Field-d (p < 0.01, p = 0.015). The CTS of the buccal area was higher than in the lips. CONCLUSION The sublingual area has a homogenous distribution in TVD, FCD, FD, and SVMD. This study can be a description of the normal microvascular anatomy for future researches regarding microcirculatory assessment

An unexpected and devastating adverse event of dasatinib: Rhabdomyolysis

We, herein, describe a 52-year-old male whom developed rhabdomyolysis and acute renal failure likely related to dasatinib shortly after the administration of treatment. After withdrawal of dasatinib, the myalgia reduced, and his CK returned to normal levels within a week. On follow-up acute renal failure did resolve without requiring dialysis, but unfortunately the patient died of severe respiratory distress. We recommend that musculoskeletal symptoms should be monitorized during therapy with dasatinib, and CML patients with musculoskeletal symptoms should have CK levels checked in order to prevent this unexpected but devastating adverse event

A chronic myeloid leukemia case with a variant translocation t(11;22) (q23;q11.2): masked Philadelphia or simple variant translocation?

Chronic myeloid leukemia (CML) is characterized by the presence of the Philadelphia chromosome (Ph), usually due to a reciprocal translocation, t(9;22)(q34;q11.2). The remaining cases (2-10%) have variant translocation, and more rarely (~1%) a cryptic rearrangement is present which can be detected by fluorescence in situ hybridization analysis in a CML patient with a Ph-negative karyotype (Masked Ph). We present a masked/variant BCL-ABL-positive CML patient showing a t(11;22)(q23;q11.2) which was detected using a combined approach of conventional cytogenetics and reverse transcription polymerase chain reaction. In February 2013, the patient was diagnosed as having CML. Imatinib mesylate (400 mg/day), was then started. Under imatinib therapy a complete hematologic and cytogenetic response was attained. In December 2013, an increment in BCR-ABL/ABL transcript levels according to the International Scale (from 0.0471% to 1.4034%), indicating imatinib failure, was documented. Administration of nilotinib (400 mg twice daily) resulted in durable molecular response after 3 months. The patient is still on nilotinib treatment throughout the observation period with no sign of recurrence and adverse events