12th Congress of the European Hematology ... - Haematologica

agents. They involve primarily the skin and mucous membranes. Gastrointestinal
haemorrhage is observed less frequently. Although reported,
intraarticular, retroperitoneal, central nervous system and deep intramuscular
hematomas are unusual. We report the case of a patient diagnosed
of PV with spontaneous spinal epidural hematoma. Case. A 73
years old woman diagnosed three years ago of PV was admitted to the
hospital due to back pain for the last 24 hours and weakness and plegia
of her left leg. The magnetic resonance (MR) revealed the presence of a
spinal epidural hematoma that compressed spinal cord from T11-L1 on
its left side. She underwent descompressive surgical treatment (laminectomy)
without complications. The patient didn´t refer aspirin, anticoagulants
or similar agents intake and/or prior trauma; the last phlebotomy
was performed 3 months ago. Tests: Hg 14.8 g/dL, VCM 66.3 fL, Leucocytes
23.3×10 3 /µL, Platelets 138×10 3 /µL, APTT 30.7 sec (30-41), Prothrombin
time 13.04 sec (10-14), Fibrinogen 3.0 g/L (1.4-4.0), PFA-100 ® :
col/ADP 121 sec (71-118), col/Epi > 300 sec (85-165), FvWAg 183%,
FvWRCo 150.1%, FVIII:C 160.6%. Platelet optical aggregometry:
decreased primary and secondary aggregation to ADP and epinephrine,
decreased response to collagen. Flow cytometry: Normal expression of
GpIb; p-selectin expression (without ADP): 64,67% (normal controls: 4-
18.4%), p-selectin expression (with ADP) 82.2% (normal controls: 11.3-
57.4%) showing platelet hyperreactivity. 36 hours after surgery she presented
acute paraplegia due to hematoma in the surgical area from skin
to spinal cord, surgical evacuation was required. Platelet transfusion
every 2 days was administered for a week until no evidence of bleeding
complications was observed. Our patient is now under spinal cord injury
rehabilitation program. Conclusions. 1) Even without anticoagulants or
antiplatelet agents intake and with normal platelet counts, patients with
chronic myeloproliferative disease (CMPD) may develop severe bleeding.
2) Co-existence of platelet hyperreactivity and changes in platelet
aggregation patterns has been described in CMPD in the same patient,
as observed in this case. 3) Neverthless there is no specific assay to predict
hemorrhagic diathesis in CMPD patients.
1415
NEW RESTRICTIVE PROPHYLACTIC PLATELETS TRANSFUSION THRESHOLD IN CANCER
PATIENTS WITH STEM CELLS TRANSPLANTATION
S. Attalla, 1 M. Alam, 2 G. Elwahidi, 2 O. Salama3 1 Dr. Soliman Fakeeh Hospital, JEDDAH, Saudi Arabia; 2 Faculty of Medicine.
Dept. of Oncology, MANSOURA, Egypt; 3 Dept. of Hematology, Faculty of
Medicine, MANSOURA, Egypt
Background. Prophylactic platelets transfusion are usually administered
to patients receiving stem cell transplantation (SCT) when their platelets
count falls below 10×10 9 /L. Some observations suggest that lower
platelets count can be used in patients with stable condition but the safety
of lower threshold is uncertain. Aims. To compare the risk of bleeding
complications and the number of platelet and red cell transfusion
administered using two different prophylactic platelets transfusion protocols.
Methods. We evaluated 30 patients with hematological malignancies
and solid tumors who received autologous and allogenic stem cells
transplantation. 12 patients have received prophylactic platelets transfusion
when their platelets count decreased below 10×10 9 µ/L and 18
patients received at threshold below 5×10 9 /L. Results. Decreasing the
threshold of prophylactic platelet transfusion from 10×10 9 /L to 5×10 9 µ/L
resulted in reduction of platelet transfusion units from (10.4±6.1
unit/patient) to (1.3±4.1 unit/patient ) during the period of bone marrow
aplasia (95 percent confidence interval for mean was 6.5to14.3 and 0.9
to 2.7respectively) and decreased the number of patients received
platelets transfusion from 100% to 11.1%(p=0.001). The incidence of
bleeding was statistically non significant in comparison of patients with
threshold 10 ×10 9 /L(10%) with patients with threshold 5×10 9 (11.1%)
(p=0.125). Logistic regression analysis of complications in both groups
with other variables (age above and below 40 years, sex, duration from
diagnosis till bone marrow transplantation, platelet refractoriness, days
of thrombocytopenia, platelets count in nadir, and number of platelets
units transfused) showed only significant regression with both, platelet
refractoriness (p= 0.0117) and odds ratio (97.8 )and with the number of
transfused platelet units (p= 0.022) and odds ratio (1.3) Summary/Conclusion.
Prophylactic platelets transfusion threshold can be decreased safely
from 10×10 9 /L to 5×10 9 /L in patients undergoing SCT with stable condition,
normal organs functions and intact haemostatic system, which
makes further clinical studies are required to answer the question of
whether there is even a need for prophylactic platelet transfusion or
whether platelet transfusion should be administered only when active
bleeding is documented.
12 th Congress of the European Hematology Association
1416
BLOODSTREAM INFECTIONS IN ADULT PATIENTS WITH MALIGNANT BLOOD DISORDERS
AND NEUTROPENIA: MICROBIAL SPECTRUM AND ANTIMICROBIAL SUSCEPTIBILITY
PATTERN
S. Levidiotou, 1 P. Bouranta, 2 C. Gartzonika, 3 D. Papamichail, 3
K.L. Bourantas1 1 Medical School/ University of Ioannina, IOANNINA; 2 Medical School/University
of Ioannina, IOANNINA; 3 Medical School of Ioannina, IOANNINA,
Greece
Background. Bloodstream infections are a major cause of morbility and
mortality among patients with haematological disorder. Aim. The aim of
the present study was the bacterial spectrum and antimicrobial susceptibility
pattern of organisms causing bloodstream infections among
patients hospitalized in a hematology center. Methods. A total of 146
episodes of bacteraemia and fungaemia in 109 patients were identified.
All patients were treated in the haematology ward during a 7-year period
(2000-2006) and had an underlying haematological disorder (lymphoma,
leukaemia and myeloma). There were 73 male and 36 female
patients, aged 17-80 years old. Results. A total of 164 microbial strains
were isolated in 146 episodes. Forty-seven (47.6%) isolates were Gramnegative
bacteria, 48.1% Gram-positive bacteria and 4.3% yeasts.
Polymicrobial bacteraemia was observed in 17 from 146 (11.6%)
episodes. The dominated pathogens were coagulase-negative Staphylococci
(CNS) 26.2%, Pseudomonas aeruginosa 18.3%, E. coli 14%, Enterococcus
spp. 7.9% and S. aureus 5.5%. The mortality rate was 19.3%
(21 patients) being higher in patients with bacteraemia caused by P.
aeruginosa, CNS and Klebsiella spp. Oxacillin resistance was detected in
3/9 (33.3%) of S. aureus isolates and in 29/43 (67.5%) of CNS. Vancomycin
resistance was detected only in two strains Enterococcus spp.
(15.4%). Four strains E. coli produced ESBL (17.4%). Among P. aeruginosa
isolates, 16 were resistant to colistin (53.3%) and 22 to carbapenems,
fluorquinolones and ceftazidime (73.3%). Conclusions. The identification
of the microbiology profile of bloodstream infections and antimicrobial
susceptibility pattern of isolated strains may help in managing
these infections in haematology patients, and reviewing infection control
and antibiotic policies.
1417
PRIMARY LYMPHOMA OF THE LIVER: CLINICAL FEATURES AND OUTCOME
OF 10 PATIENTS
M. Stein
Rambam Health Care Campus, HAIFA, Israel
Background. Primary liver lymphoma (PLL) is a rare lympho-proliferative
disorder, presenting in less than 1% of all extranodal lymphomas.
The etiology of PLL is unknown and the prognosis is dismal. Early stage,
localized PLL generally does better than that with advanced stage.
Lymph node and bone marrow involvement are considered as poor prognostic
factors. Aims. A retrospective study to review our departmental
experience with PLL. Methods. From 1985-2001, 10 patients who fulfilled
the diagnostic criteria for PLL were treated at our hospital. All
patients underwent a thorough work-up and were staged accordingly.
Results. There were six males and four females [age range, 45-81 years;
mean 63 years]. Main presenting symptoms were abdominal pain (localized
to the right upper quadrant with/without radiating character),
weakness, loss of appetite and weight. No patient presented with jaundice.
Only three patients exhibited clear B symptoms. Three patients
presented with hepatomegaly. Liver functions tests were elevated in all
patients and LDH in two patients. Imaging (CT, US, Gallium scan) exhibited
typical, unspecific findings, such as solitary or multiple lesions, filling
defects, signs of hepatocellular damage and pathological uptake. Five
patients had stage I/II and five had stage IV disease. A total of 80%
exhibited diffuse, large, B-cell lymphoma. The rest had immunoblastic,
mixed or anaplastic (high grade) lymphomas (all B-cell type). Eight
patients were treated with conventional CHOP (cyclophosphamide,
doxorubicin, vincristine, prednisone) and two were treated with a highdose
CHOP regimen; all achieved good partial remission or complete
remission for a mean of six months. Relapses occurred at multiple sites.
Relapsing patients were treated with DVIP (cisplatin, etoposide (VP-16),
ifosfamide, dexamethasone) with a good partial remission for about
three months. One patient died of a massive stroke after eight months
of complete remission with no evidence of disease. Another patient
developed massive recurrent disease following 35 months of sustained
complete remission. Conclusions. PLL should be considered in the differential
diagnosis of any patient with non-specific solitary or multiple liv-
haematologica/the hematology journal | 2007; 92(s1) | 507