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Genc DB, Yildirmak ZY, Sari F, Uzak I. Severe hepatic sinusoidal obstruction syndrome in a patient with Wilms tumor and hereditary spherocytosis. Int Cancer Conf J 2024; 13:93-97. [PMID: 38524657 PMCID: PMC10957841 DOI: 10.1007/s13691-023-00641-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/11/2023] [Indexed: 03/26/2024] Open
Abstract
A 7-year-old girl with a history of splenectomy for hereditary spherocytosis (HS) was diagnosed with renal hematoma after a blunt abdominal trauma while receiving aspirin. Multiple erythrocyte transfusions and transarterial embolization were performed without success. Eventual nephrectomy revealed severely necrotic and perforated Stage III Wilms tumor (WT). Radiochemotherapy was administered, but by the eighth week, she developed severe hepatic sinusoidal obstruction syndrome (HSOS). Her ferritin level at the time was 3406 ng/ml. Defibrotide and aggressive supportive measures provided full recovery. The patient was given deferasirox for iron chelation therapy and finished her treatment without incident. To our knowledge, just one patient with HS and WT has been described in the literature. The role of iron excess in HSOS pathogenesis in non-transplant patients has not been addressed before either. Transfusional hyperferritinemia, in addition to chemotherapeutics and radiation, may have contributed to the development of severe HSOS in our patient.
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Affiliation(s)
- Dildar Bahar Genc
- Department of Pediatric Hematology and Oncology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
- Sarıyer Hamidiye Etfal Training and Research Hospital, Kazım Karabekir Paşa Mah. Bahçeköy Cd. No:64, 34453 Sarıyer, Istanbul, Turkey
| | - Zeynep Yildiz Yildirmak
- Department of Pediatric Hematology and Oncology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ferhat Sari
- Department of Pediatric Intensive Care, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
- Present Address: Department of Pediatric Intensive Care, Istanbul Aydın University Medical Faculty, Istanbul, Turkey
| | - Ismail Uzak
- Department of Pediatrics, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Celik SS, Genc DB, Yildirmak ZY. Clinical Characteristics and Treatment Outcome of Hereditary Spherocytosis: A Single Center's Experience. Sisli Etfal Hastan Tip Bul 2023; 57:531-535. [PMID: 38268662 PMCID: PMC10805049 DOI: 10.14744/semb.2023.60370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 07/01/2023] [Accepted: 08/10/2023] [Indexed: 01/26/2024]
Abstract
Objectives The objective of the study is to present the demographic characteristics, clinical and laboratory features and outcome of our patients with hereditary spherocytosis (HS). Methods Demographic, clinical, and laboratory data; complications; and splenectomy results were analyzed retrospectively. The severity of the disease was scaled according to Eber's criteria. Results Sixty-nine patients (42 boys, 27 girls, median age: 3 years) were eligible. Sixty-eight percent of the patients had a history of neonatal jaundice. The complaints at admission were jaundice (71%), fatigue (27.5%), fainting (4.3%), and pallor (4.3%). The median follow-up duration was 8.5 years. According to Eber's criteria, three (4.3%), 57 (82.6%), and nine (13.1%) patients had mild, moderate, and severe diseases, respectively. Thirty-six patients (52.1%) had a splenectomy. Following splenectomy, we observed a significant rise in hemoglobin levels and a decline in indirect bilirubin levels. Post-operative thrombocytosis was common, with a tendency to fall and stabilize after 1 month. There were no thromboembolic complications. Conclusion In spite of the high rate of consanguinity, familial history of HS, and neonatal jaundice in our study group, the majority of the HS patients were identified relatively late, about 3 years. This finding shows that HS might be insufficiently acknowledged by primary care. Splenectomy, in selected cases, may reduce the need for transfusions. Post-splenectomy transient thrombocytosis is common and has a benign course.
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Affiliation(s)
- Senanur Sanli Celik
- Department of Pediatrics, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Dildar Bahar Genc
- Department of Pediatric Oncology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Zeynep Yildiz Yildirmak
- Department of Pediatric Hematology/Oncology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
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Dagdeviren Cakir A, Yildirmak ZY, Eren S, Özdemir EM, Özdemir M, Uçar A. Prolonged Bleeding After Dental Extraction Due to Decreased Serum Level of Von Willebrand Factor Caused by Untreated Profound Hypothyroidism. J Pediatr Hematol Oncol 2023; 45:e660-e661. [PMID: 36706297 DOI: 10.1097/mph.0000000000002617] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/03/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Delayed diagnosis of hypothyroidism may result in atypical presentations. Here, we report a case with decreased serum level and activity of von Willebrand factor due to untreated profound hypothyroidism. OBSERVATION A 9-year-old girl, presented with prolonged gingival bleeding after dental extraction. Clinical findings of the case were consistent with hypothyroidism, and the laboratory workup results revealed decreased serum level and activity of von Willebrand factor associated with profound hypothyroidism. Restoration of euthyroidism normalized the coagulation parameters. CONCLUSION Delayed diagnosis of hypothyroidism may lead to atypical presentations such as bleeding diathesis. Profound hypothyroidism should be considered in the differential diagnosis of acquired von Willebrand disease to avoid undue treatment.
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Affiliation(s)
| | - Zeynep Yildiz Yildirmak
- Pediatric Hematology and Oncology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Simge Eren
- Departments of Pediatric Endocrinology and Diabetes
| | | | | | - Ahmet Uçar
- Departments of Pediatric Endocrinology and Diabetes
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Genc DB, Akinci N, Yildirmak ZY, Vural S. Renal Ultrasonographic Abnormalities at Initial Presentation of Children Diagnosed with Acute Lymphoblastic Leukemia and Long-Term Renal Functions and Prognosis in Survivors. Sisli Etfal Hastan Tip Bul 2022; 56:421-426. [PMID: 36304210 PMCID: PMC9580970 DOI: 10.14744/semb.2022.89646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/15/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES The kidney is a vulnerable organ for acute lymphoblastic leukemia (ALL), by the disease, and various associated clinical pictures. This retrospective study aims to document renal ultrasound abnormalities in children with newly diagnosed ALL as well as to investigate the correlation between renal findings and clinical/laboratory/survival data. METHODS All children (age <18 years) with ALL were included in the study. An increase in size/nephromegaly (NM) or hyperechogenicity (HE) of the kidneys at first admission was accepted as a pathological renal abnormality. The clinical/laboratory findings, survival, and long-term renal functions were compared between patients with and without NM/HE. RESULTS The incidence of NM±HE was 12% in 163 patients. Enlargement of spleen, liver, or both and, hypercreatininemia was independently correlated with the presence of NM/HE. After the induction therapy, ultrasound findings were resolved in all patients, and NM/HE did not influence ALL prognosis. All survivors had normal renal functions in long term. CONCLUSION The renal ultrasound abnormalities are not uncommon in children with leukemia at admission, without a negative impact on leukemia prognosis and on long-term renal functions.
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Affiliation(s)
- Dildar Bahar Genc
- Department of Pediatric Hematology and Oncology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Nurver Akinci
- Department of Pediatric Nephrology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Zeynep Yildiz Yildirmak
- Department of Pediatric Hematology and Oncology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Sema Vural
- Department of Pediatric Hematology and Oncology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
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Kalay Senturk NG, Dagdeviren Cakir A, Yildirmak ZY, Ucar A. Assessment of Serum Spexin Levels in Obese Adolescents with Metabolic Syndrome Antecedents: Preliminary Results. Horm Res Paediatr 2022; 94:343-352. [PMID: 34839286 DOI: 10.1159/000521180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/25/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Spexin (SPX) is a novel peptide implicated in food intake and satiety. SPX levels are reduced in obese patients. AIM This study aimed to compare serum SPX levels in obese adolescents versus healthy controls and to assess the associations of metabolic syndrome (metS) antecedents with serum SPX levels. METHODS Eighty consecutive obese adolescents aged 10-18 years and 80 healthy peers were enrolled. Anthropometric measurements, pubertal examinations, and clinical blood pressure measurements were performed. Fasting blood samples were drawn for glucose, insulin, lipids, uric acid, alanine aminotransferase (ALT), and SPX. metS was diagnosed using International Diabetes Federation criteria. Associations of serum SPX with clinical and laboratory variables were assessed. RESULTS Obese adolescents had lower serum SPX levels than healthy peers (50 pg/mL [25-75% IQR: 25-98 pg/mL] and 67.0 pg/mL [25-75% IQR: 32.5-126.0 pg/mL]; respectively, p = 0.035). Twenty (25%) obese adolescents were diagnosed as having metS. Obese adolescents with metS had lower SPX than those without metS (24.5 pg/mL [25-75% IQR: 15.3-49.5 pg/mL] and 69.0 pg/mL [25-75% IQR: 42.0-142.0 pg/mL]; respectively, p < 0.0001). The frequencies of hyperuricemia, IR, and elevated ALT were similar in obese adolescents with metS and those without metS (p > 0.05 for all). Serum uric acid levels were correlated significantly with serum SPX after correcting for BMI and HOMA-IR (r = -0.41, p < 0.05). A serum SPX level at a cutoff level of 49.5 pg/mL predicted the presence of metS in obese adolescents with 75% sensitivity and 71% specificity. CONCLUSIONS Obese adolescents have reduced SPX levels, and this reduction is more pronounced in those with metS. Further research is needed to verify the utility of SPX as a biomarker in the diagnosis of metS in obese adolescents.
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Affiliation(s)
- Nida Gulderen Kalay Senturk
- Department of Pediatrics, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Aydilek Dagdeviren Cakir
- Department of Pediatric Endocrinology and Diabetes, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Zeynep Yildiz Yildirmak
- Department of Pediatric Hematology and Oncology, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ahmet Ucar
- Department of Pediatric Endocrinology and Diabetes, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Ozturk Onsal FD, Ucar A, Bulbul A, Yildirmak ZY, Elitok GK. Associations of Size at Birth and Metabolic Syndrome Antecedents With Serum Spexin Levels in Prepubertal Children. J Endocr Soc 2021. [PMCID: PMC8089865 DOI: 10.1210/jendso/bvab048.1445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Spexin is a novel peptide implicated in food intake and obesity. The primary aim of this study was to analyze whether serum spexin levels, along with total leptin and active ghrelin levels were different in prepubertal children born small for gestational age(SGA) and appropriate for gestational(AGA). Secondary aims were to analyze whether serum spexin, leptin and active ghrelin levels correlated with metabolic syndrome(MS)antecedents according to the Dietary and lifestyle-induced health effects in children and infants (IDEFICS)study. Subjects and Methods: We conducted a cross-sectional study on prepubertal37SGA- (median:5.6yr)and50prepubertalAGA-born children(median:5.9yr). Anthropometric data, homeostasis model assessment of insulin resistance(HOMAIR),plasma lipids, serum spexin, total leptin and active ghrelin levels were analyzed. Associations of serum spexin levels with MS antecedents according to the IDEFICS study were investigated. Results: Children bornSGA had higher body mass index and waist circumference than AGA-born peers(p <0.05). Serum total leptin levels were higher in SGA-born children than in AGA-born peers (p<0.05). Plasma active ghrelin and spexin levels were not different between the subgroups(p>0.05). Children bornSGA had higher MS risk scores than AGA-born peers(p <0.05). Small for gestational age- born children had higher plasma glucose,insulin and HOMA-IR than AGA-born peers(p<0.05). In children born SGA, the number of subjects with excess adiposity (NSGA=18(43.9%)andNAGA=7(14%),p=0.016)and insulin resistance(NSGA=14(34%) andNAGA=6(12%),p=0.035)was higher than in AGA-born peers. There was no significant difference in frequency of dyslipidemia between the subgroups(p=0.19). The frequency of children with more than one MS antecedent was higher in SGA-born children than in AGA-born peers(Chi-Square p <0.01). Metabolic syndrome risk score according to IDEFICS was higher in SGA born children than in AGA-born peers(2.2±1.8vs1.1±1.8;p=0.008). Serum spexin levels were lower in children with MS antecedents than those without MS antecedents in both AGA -and SGA-born children[Serum spexin levels in AGA-born children with and without MS antecedents: 48,5pg/mL(25-75%IQR:19.8-93.8pg/mL)and143pg/mL(25-75%IQR:104-211pg/mL),p<0.001;respectively, serum spexin levels inSGAborn children with and without MS antecedents: 31,0pg/mL(25-75%IQR:16.5-47.0 pg/mL) and79.5pg/mL(25-75% IQR:49.5-274.8pg/mL),p=0,0016;respectively]. In the whole study group, the most important factor associated with excess adiposity was history of being born SGA(OddsRatio=91.3[95%CI:2.2-374;p=0.017] Conclusions: Serum spexin levels were not different inSGA- and AGA-born children. Serum spexin levels were reduced in children with MS antecedents independent of size at birth.
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Affiliation(s)
- Fatma Duygu Ozturk Onsal
- University of Health Sciences,Sisli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Ahmet Ucar
- University of Health Sciences,Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ali Bulbul
- University of Health Sciences,Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Zeynep Yildiz Yildirmak
- University of Health Sciences,Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Gizem Kara Elitok
- University of Health Sciences,Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Erbilgin Y, Firtina S, Mercan S, Hatirnaz Ng O, Karaman S, Tasar O, Karakas Z, Celkan TT, Zengin E, Sarper N, Yildirmak ZY, Sisko S, Ozbek U, Sayitoglu M. Prognostic gene alterations and clonal changes in childhood B-ALL. Leuk Res 2019; 83:106159. [PMID: 31228652 DOI: 10.1016/j.leukres.2019.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/17/2019] [Accepted: 05/22/2019] [Indexed: 12/20/2022]
Abstract
Genomic profiles of leukemia patients lead to characterization of variations that provide the molecular classification of risk groups, prediction of clinical outcome and therapeutic decisions. In this study, we examined the diagnostic (n = 77) and relapsed (n = 31) pediatric B-cell acute lymphoblastic leukemia (B-ALL) samples for the most common leukemia-associated gene variations CRLF2, JAK2, PAX5 and IL7R using deep sequencing and copy number alterations (CNAs) (CDKN2A/2B, PAX5, RB1, BTG1, ETV6, CSF2RA, IL3RA and CRLF2) by multiplex ligation proximity assay (MLPA), and evaluated for the clonal changes through relapse. Single nucleotide variations SNVs were detected in 19% of diagnostic 15.3% of relapse samples. The CNAs were detected in 55% of diagnosed patients; most common affected genes were CDKN2A/2B, PAX5, and CRLF2. Relapse samples did not accumulate a greater number of CNAs or SNVs than the cohort of diagnostic samples, but the clonal dynamics showed the accumulation/disappearance of specific gene variations explained the course of relapse. The CDKN2A/2B were most frequently altered in relapse samples and 32% of relapse samples carried at least one CNA. Moreover, CDKN2A/2B alterations and/or JAK2 variations were associated with decreased relapse-free survival. On the other hand, CRLF2 copy number alterations predicted a better survival rate in B-ALL. These findings contribute to the knowledge of CDKN2A/2B and CRLF2 alterations and their prognostic value in B-ALL. The integration of genomic data in clinical practice will enable better stratification of ALL patients and allow deeper understanding of the nature of relapse.
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Affiliation(s)
- Yucel Erbilgin
- Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Sinem Firtina
- Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey; Istinye University, Faculty of Arts and Sciences, Istanbul, Turkey
| | - Sevcan Mercan
- Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey; Kafkas University, Faculty of Engineering, Kars, Turkey
| | - Ozden Hatirnaz Ng
- Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey; Acibadem Mehmet Ali Aydinlar University Medical Faculty, Istanbul, Turkey
| | - Serap Karaman
- Istanbul University, Aziz Sancar Institute of Experimental Medicine, Istanbul, Turkey
| | - Orcun Tasar
- Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Zeynep Karakas
- Istanbul University, Aziz Sancar Institute of Experimental Medicine, Istanbul, Turkey
| | | | - Emine Zengin
- Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Nazan Sarper
- Kocaeli University Medical Faculty, Kocaeli, Turkey
| | | | - Sinem Sisko
- Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Ugur Ozbek
- Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey; Acibadem Mehmet Ali Aydinlar University Medical Faculty, Istanbul, Turkey
| | - Muge Sayitoglu
- Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.
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