Disorders Mimicking Myelodysplastic Syndrome and Difficulties in its Diagnosis

Myelodysplastic morphology of blood cells can be encountered not only in myelodysplastic syndrome (MDS) but also in nonclonal disorders like viral, bacterial, parasitic infections, juvenile rheumatoid arthritis, polyarteritis nodosa, immune thrombocytopenic purpura (ITP), iron deficiency anemia, megaloblastic anemia, dysgranulopoietic neutropenia, congenital neutropenia, cases with microdeletion 22q11.2, malignant lymphoma, after administration of granulocyte colony stimulating factor, chemotherapy, steroids, smoking, alcohol, posttransplantation, copper deficiency also, together with or without cytopenia. Absence of cytogenetic abnormality in 50–70% of cases with MDS, some overlapping morphological and/or pathophysiological features make it challenging to differentiate between MDS and other diseases/disorders like aplastic anemia, refractory ITP, copper deficiency. Transient genetic abnormalities including monosomy 7 in megaloblastic anemia; increased immature myeloid cells in bone marrow of cases with copper, vitamin B12, or folic acid deficiency in the setting of cytopenia and dysmorphism may also lead to the misdiagnosis of MDS. On the other hand, there are also cases of transient MDS. In this chapter, a literature is be presented to draw attention of the readers on the disorders that mimic MDS. Additionally, our personal experiences are also be shared. Awareness of disorders mimicking MDS may prevent over- or underdiagnosis of MDS

The Estimation of Peatlands Reserve on Carbon in the Forest and Shrubs That Has Been Drained

Global warming and greenhouse gas emissions (GHGs) became a hot issue in the world today. An increased concentration of carbon in the atmosphere becomes one of the serious problems that can affect life on Earth. Peatlands pointed out as one of the sources of GHG emissions. Drainage of peatlands cause decreased water level so that the decomposition process is faster on a layer above the groundwater table, thus affecting the chemical characteristics of peat. In addition to affecting the ground water level, drainage also leads to a decrease in surface height peat soil (subsidence). Given the magnitude of the role of drainage and land use types in affecting carbon stocks and emissions of CO2 on peat soil, this study is to measure carbon stocks and emissions of CO2 on peat soil in forests and shrubs that have been drained. CO2 emissions increase with the closer spacing of the drainage channel that is at a distance of 50 m to 500 m of drainage channels. Meanwhile, at a distance of 5 m and 10 m of the drainage channel can not be concluded because of the condition of ground water that is stagnant at the time of sampling gas, so be very low CO2 emissions. CO2 emissions on the use of forest land are higher than the shrub land

Parvovirus-B19 and Hematologic Disorders

Parvovirus-B19 (PV-B19) is a member of Parvoviridae, which is one of the smallest DNA viruses. PV-B19-associated diseases usually serve as a good representation of the balance of virus, host response and the immune system. The diseases manifested with PV-B19 are erythema infectiosum, which is common in children, hydrops fetalis, transient pure red cell aplasia in patients with chronic hemolytic anemia, arthralgia - mostly observed in women, and chronic pure red cell aplasia in immunocompromised individuals. Cytopenia (bicytopenia, monocytopenia or pancytopenia) may also accompany the diseases mentioned above. On the other hand, there are many diseases, including neurologic, vasculitic, hepatic, rheumatoid, nephritic, autoimmune, myocardial, and others in which the mechanisms of the diseases are not clear, which may be associated with PV-B19. The virus may manifest with unexpected and unexplained clinical pictures and lead to misdiagnosis. Therefore, hematologic disorders in any unestablished clinical diagnosis should be investigated for PV-B19 infection. However, serologic examination for PV-B19 diagnosis is not sufficient in immunocompromised status. The virus can be determined with polymerase chain reaction (PCR) in the serum or tissue samples. Supportive therapy, blood transfusion and immunoglobulin are the conventional therapeutic interventions for PV-B19 today. Vaccination studies are under examination. (Turk J Hematol 2010; 27: 224-33)WoSScopu

An Unusual Case of Reactive Lymphocytosis Mimicking Acute Leukemia

The diagnosis of acute leukemia is based on a combination of clinical, hematological, morphological, cytogenetic, and immunophenotypic data. The authors report a case of reactive lymphocytosis with extremely elevated lymphocytic and lymphoblastic leukocytosis that mimicked acute lymphoblastic leukemia, not only morphologically, but also in immunophenotypic analysis. They could not determine any underlying disease marker other than infectious symptoms that were present for 20 days prior to presentation to their clinic. Although this case presented with extremely high lymphocytic leukocytosis, the patient had normal blood cell lineage, a moderate level of blastic cells in bone marrow, and normal physical findings. These findings convinced the authors to follow up the patient before beginning treatment.Wo

Varicella Zoster-Associated Severe Aplastic Anemia in a Child and Its Successful Treatment with Peripheral Blood Stem Cell Transplantation from HLA-5/6-Identical Donor

Background: Varicella zoster virus is very rarely associated with aplastic anemia. Bone marrow transplantation from an HLA-identical sibling is the treatment of choice. Case report: A seven-year-old boy presented with aplastic anemia (AA) following chicken pox infection. No clinical improvement was observed with pharmaceutical therapy and peripheral blood stem cell transplantation (PBSCT) was performed from his HLA 5/6 identical mother. Since the transplantation, the patient has had a durable, trilineage hematological response for 12 months. Conclusions: The present case with varicella zoster-associated aplastic anemia was non-responsive to conventional therapies (ATG protocol, ALG protocol, oxymethalone, and cyclosporine A) and successfully treated with bone marrow transplantation from his 5/6 identical mother.Wo

The evaluation of acquired aplastic anemia in children and unexpected frequency of varicella-zoster virus association: a single-center study.

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Hepatitis B Immunoglobulin in Combination with Lamivudine for Prevention of Hepatitis B Virus Reactivation in Children Undergoing Bone Marrow Transplantation

Abstract: There is little information in literature about the use of hepatitis B immunoglobulin (HBIg) in recipients of bone marrow transplantation (BMT). Here, we report two children who received IV HBIg (Hepatect‐CP) and lamivudine treatment during BMT course for either patient or donor hepatitis B virus (HBV) viremia. A four‐year‐old girl underwent a fully human leukocyte antigen‐matched allogeneic BMT for thalassemia major from her mother positive for hepatitis B surface antigen (HBsAg). A 12‐yr‐old boy with chronic myeloid leukemia, positive for HBsAg and HBV‐DNA received a fully HLA‐matched allogeneic BMT from his sister in the first chronic phase of the disease. HBIg was successfully used in both cases to prevent HBV reactivation of the recipients. The results of our observations are encouraging and we suggest that HBIg in combination with lamivudine may be used in such cases especially in post‐transplant early period to prevent HBV reactivation.Wo

Transcobalamin Ii Deficiency In Four Cases With Novel Mutations

Objective: Transcobalamin II deficiency is one of the rare causes of inherited vitamin B12 disorders in which the patients have characteristically normal or high vitamin B12 levels related to the transport defect of vitamin B12 into the cell, ending up with intracellular cobalamin depletion and high homocysteine and methylmalonic acid levels. Materials and Methods: Herein, we describe the findings at presentation of four patients who were diagnosed to have transcobalamin II deficiency with novel mutations. Results: These patients with transcobalamin II deficiency were found to have novel mutations, of whom 2 had the same large deletion (homozygous c.1106+1516-1222+1231del). Conclusion: Transcobalamin II deficiency should be considered in differential diagnosis of any infant with pancytopenia, failure to thrive, diarrhea, and vomiting.PubMedWoSScopu

Intravenous Immunoglobulin in The Treatment of Severe MethotrexateInduced Acral Erythema

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