Acute Leukemia and Pregnancy

The combination of acute leukemia and pregnancy is infrequent. It is estimated to occur in less than 1 in 75,000 pregnancies. Maternal and fetal outcomes have improved substantially in recent years. In general, multi-agent chemotherapy is given as soon as the diagnosis of leukemia is established, even if it is in the first trimester. There are two important considerations in the management of a patient with leukemia during pregnancy, the mother who needs optimal cancer therapy and the developing fetus who could potentially be affected by the disease and/or the teratogenicity of antineoplactic agents. Vaginal delivery is preferable, and caesarian section is reserved for obstetrical indications only

The role of sclerostin/dickkopf-1 and receptor activator of nuclear factor kB ligand/osteoprotegerin signalling pathways in the development of osteoporosis in patients with haemophilia A and B: A cross-sectional study

Aim: Haemophilia A and B are associated with reduced bone mineral density (BMD). The aim of this study was to assess circulating sclerostin and dickkopf-1 (Dkk-1), (inhibitors of osteoblastic differentiation), as well as the receptor activator of nuclear factor kB ligand (RANKL)/osteoprotegerin (OPG) system (the major regulator of osteoclastogenesis), in patients with haemophilia (PWH), their possible correlations with clinical risk factors and the effect of ibandronate on these markers. Methods: Eighty-nine male PWH (mean age 45.9 ± 15.3 years) and 30 age-matched healthy male controls participated. BMD was assessed by DXA. Sclerostin, Dkk-1, RANKL and OPG were measured in serum of patients, controls, as well as in ten patients receiving oral ibandronate (150 mg/mo), at baseline and after 12 months. Results: Patients with haemophilia had lower circulating sclerostin (median ± IQR: 47.4 ± 26.93 vs 250 ± 250 pmol/L, P <.001), Dkk-1 (21.24 ± 17.18 vs 26.16 ± 15.32pg/mL, P =.04) and higher levels of RANKL (0.23 ± 0.03 vs 0.04 ± 0.03 pmol/L, P =.001), RANKL/OPG ratio (0.063 ± 0.25 vs 0.005 ± 0.11, P =.001) compared with controls. Patients with low BMD had higher OPG concentrations compared to those with normal BMD. Sclerostin and RANKL/OPG correlated positively with BMD. Patients with severe haemophilia had lower sclerostin concentrations compared with those with mild or moderate disease. The degree of arthropathy negatively correlated with sclerostin and Dkk-1 levels. PWH who received ibandronate showed a decrease in serum Dkk-1 without any significant effect on sclerostin and RANKL/OPG. Conclusions: Patients with haemophilia present increased osteoclastic activity coupled with compensatory increased osteoblastic activity. Ibandronate did not affect RANKL/OPG ratio, but it decreased Dkk-1. © 2017 John Wiley & Sons Lt

Factors associated with the occurrence of epistaxis in natural canine leishmaniasis (Leishmania infantum)

Background: Canine leishmaniasis (CanL) is a common cause of epistaxis in dogs residing in endemic areas. The pathogenesis of CanL-associated epistaxis has not been fully explored because of the limited number of cases reported so far. Hypothesis: Epistaxis in CanL could be attributed to more than 1 pathomechanism such as hemostatic dysfunction, biochemical abnormalities, chronic rhinitis, and coinfections occurring in various combinations. Animals: Fifty-one dogs with natural CanL. Methods: The allocation of 51 dogs in this cross-sectional study was based on the presence (n = 24) or absence (n = 27) of epistaxis. The potential associations among epistaxis and concurrent infections (Ehrlichia canis, Bartonella spp., and Aspergillus spp.), biochemical and hemostatic abnormalities, and nasal histopathology were investigated. Results: Hypergammaglobulinemia (P = .044), increased serum viscosity (P =.038), decreased platelet aggregation response to collagen (P = .042), and nasal mucosa ulceration (P =.039) were more common in the dogs with epistaxis than in those without epistaxis. The other significant differences between the 2 groups involved total serum protein (P = .029) and gamma-globulin (P = .013) concentrations, which were higher, and the percentage platelet aggregation to collagen, which was lower (P = .012) in the epistaxis dogs. Clinical Importance: CanL-associated epistaxis appears to be the result of multiple and variable pathogenetic factors such as thrombocytopathy, hyperglobulinemia-induced serum hyperviscosity, and nasal mucosa ulceration

FVIII inhibitor development according to concentrate: Data from the EUHASS registry excluding overlap with other studies

PubMed ID: 26208036[No abstract available