Hematologic Disorders

The Role of Vitamin D in Hematopoietic Stem Cell Transplantation: Implications for Graft-versus-Host Disease-A Narrative Review

INTRODUCTION/AIM

Vitamin D plays a crucial role in immune modulation, which may influence the development of graft-versus-host disease (GvHD) in patients undergoing hematopoietic stem cell transplantation (HSCT). This study aims to evaluate the impact of vitamin D levels and supplementation on the incidence of GvHD in HSCT patients.

METHODS

A narrative review was conducted across PubMed/Medline, Cochrane Library, CINAHL, and Embase databases.

RESULTS

The reviewed studies indicated widespread vitamin D deficiency among HSCT patients, with baseline levels ranging from 12.8 to 29.2 ng/mL. Supplementation protocols varied significantly, with dosages ranging from 1000 IU/day to 60,000 IU/week. Post-supplementation levels improved in some studies. Studies exploring the relationship between vitamin D and GvHD showed mixed results. Lower baseline vitamin D levels were associated with an increased risk of acute GvHD in some studies, while others found no significant correlation. However, a significant association between low levels of vitamin D and the incidence of chronic GvHD was observed.

CONCLUSION

Vitamin D deficiency is prevalent in HSCT patients and may influence the risk of developing chronic GvHD. Future research should focus on larger and more rigorous studies to determine the optimal role of vitamin D as an adjuvant therapy in the context of HSCT.

Efficient and Highly Accurate Diagnosis of Malignant Hematological Diseases Based on Whole-Slide Images Using Deep Learning

Hematopoietic disorders are serious diseases that threaten human health, and the diagnosis of these diseases is essential for treatment. However, traditional diagnosis methods rely on manual operation, which is time consuming and laborious, and examining entire slide is challenging. In this study, we developed a weakly supervised deep learning method for diagnosing malignant hematological diseases requiring only slide-level labels. The method improves efficiency by converting whole-slide image (WSI) patches into low-dimensional feature representations. Then the patch-level features of each WSI are aggregated into slide-level representations by an attention-based network. The model provides final diagnostic predictions based on these slide-level representations. By applying the proposed model to our collection of bone marrow WSIs at different magnifications, we found that an area under the receiver operating characteristic curve of 0.966 on an independent test set can be obtained at 10× magnification. Moreover, the performance on microscopy images can achieve an average accuracy of 94.2% on two publicly available datasets. In conclusion, we have developed a novel method that can achieve fast and accurate diagnosis in different scenarios of hematological disorders.

Perioperative Management of Orthopaedic Patients with Hematologic Disorders: A Critical Analysis Review

Perioperative management of orthopaedic patients with a hematologic disorder is a complex endeavor that requires a multidisciplinary team-based approach. A team composed of an experienced orthopaedic surgeon, an anesthesiologist, and a hematologist is necessary to achieve optimal outcomes. Patients with hemophilia and other complex hematologic disorders should be managed at, or in consultation with a hematologist at, a comprehensive hemophilia center. Bleeding disorders and inherited thrombophilia present unique challenges for the perioperative management of orthopaedic surgery. Comprehensive preoperative planning and familiarity with treatment guidelines can help to minimize these risks. Knowledge of the disease processes outlined in this article will provide orthopaedic surgeons with the requisite background knowledge that is needed to initiate safe and effective treatment strategies involving this high-risk patient population.