Turkish Journal of Hematology Volume: 31 - Issue: 4

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Işık P, et al: Intravenous Cyclosporine Anaphylaxis Turk J Hematol 2014;31:432-433 suppression in bone marrow recipients may facilitate the rare reaction to castor oil [7]. In conclusion, in the case of anaphylaxis with the parenteral form, oral products of cyclosporine that do not contain castor oil can be tried in patients who underwent bone marrow transplantation. Conflict of Interest Statement The authors of this paper have no conflicts of interest, including specific financial interests, relationships, and/or affiliations relevant to the subject matter or materials included. Key Words: Cyclosporine, Toxicity, Stem cell transplantation Anahtar Sözcükler: Siklosporin, Yan etki, Kök hücre nakli References 1. Bickel M, Tsuda H, Amstad P, Evequoz V, Mergenhagen SE, Wahl SM, Pluznik DH. Differential regulation of colony-stimulating factors and interleukin 2 production by cyclosporin A. Proc Natl Acad Sci U S A 1987;84:3274- 3277. 2. Ringden O. Cyclosporine in allogeneic bone marrow transplantation. Transplantation 1986;42:445-452. 3. Beauchesne PR, Chung NS, Wasan KM. Cyclosporine A: a review of current oral and intravenous delivery systems. Drug Dev Ind Pharm 2007;33:211-220. 4. Kuiper RA, Malingré MM, Beijnen JH, Schellens JH. Cyclosporine-induced anaphylaxis. Ann Pharmacother 2000;34:858-861. 5. Volcheck GW, Van Dellen RG. Anaphylaxis to intravenous cyclosporine and tolerance to oral cyclosporine: case report and review. Ann Allergy Asthma Immunol 1998;80:159- 163. 6. Gelderblom H, Verweij J, Nooter K, Sparreboom A. Cremophor EL: the drawbacks and advantages of vehicle selection for drug formulation. Eur J Cancer 2001;37:1590- 1598. 7. Takamatsu Y, Ishizu M, Ichinose I, Ogata K, Onoue M, Kumagawa M, Suzumiya J, Tamura K. Intravenous cyclosporine and tacrolimus caused anaphylaxis but oral cyclosporine capsules were tolerated in an allogeneic bone marrow transplant recipient. Bone Marrow Transplant 2001;28:421-423. 8. Nicolai S, Bunyavanich S. Hypersensitivity reaction to intravenous but not oral tacrolimus. Transplantation 2012;94:61-63. 433
Letter to the Editor DOI: 10.4274/tjh.2014.0252 Acquired Hemophilia Kazanılmış Hemofili Şinasi Özsoylu Retired Professor of Pediatrics, Hematology and Hepatology, Honorary Fellow of American Academy of Pediatrics, Honorary Member of American Pediatric Society To the Editor, I would like to highlight 3 of our patients, a 14-year-old boy and females of 4 and 41 years old [1,2] with acquired hemophilia B seen at İhsan Doğramacı Children’s Hospital (previously Hacettepe) between 1963 and 1973 among 343 patients with hemophilia [3] on account of the case of acquired hemophilia A in a 78-year-old man who was successfully treated with a combined immunosuppressive and immunoadsorption approach by Bilgin et al. as reported in a recent issue of this journal [4]. Two of our 3 patients with acquired hemophilia B, which is rarer than acquired hemophilia A, improved most likely due to corticosteroid administration in at least one case and without any intervention in the others. We have shown antibodies against factor VIII in more than 20% of patients with X-linked hemophilia A and extremely rarely in normal people in low titers [3]; however, very severe bleeding due to the presence of AHG antibodies was not frequent. On this occasion I would rather use the term ‘hereditary’ instead of ‘congenital’ hemophilia, which was used by Bilgin et al., since inheritance is not involved in most congenital disorders, such as congenital tuberculosis, syphilis, CMV, rubella infection, etc. May I also indicate that methyl prednisolone at 1 mg/kg/day may not be effective as an immunosuppressive, but 30 mg/kg/day seems to be more effective? Conflict of Interest Statement The authors of this paper have no conflicts of interest, including specific financial interests, relationships, and/or affiliations relevant to the subject matter or materials included. Key Words: Acquired hemophilia Anahtar Sözcükler: Kazanılmış hemofili References 1. Özsoylu S. Bir kız çocuğunda geçici hemofili B. Çocuk Sag ve Hast Dergisi 1964;7:101-107. 2. Özsoylu S, Özer F. Acquired factor IX deficiency: a report of two cases. Acta Haemat 1973;50:305-314. 3. Özsoylu S, Yamak B, Hiçsönmez G, Yetgin S, Pirnar A. Evaluation of 343 cases of hemophilia. Excerpta Med Int Congr Ser 1974;356:158-161. 4. Bilgin AU, Özcan M, Ayyıldız E, İlhan O. The treatment of acquired hemophilia with combination therapy of immunosuppressives and immunoadsorption. Turk J Hematol 2014;31:194-197. Reply I would like to thank you for your comment and interest in my article. Firstly you are right about this subject; hemophilia is a genetic disorder. However, congenital hemophilia is a term that can be used in literature. Secondly high dose of steroid was not preferred for this patient because of his age and comorbid disease. Aynur UĞUR BİLGİN Address for Correspondence: Şinasi ÖZSOYLU, M.D., Retired Professor of Pediatrics, Hematology and Hepatology, Honorary Fellow of American Academy of Pediatrics, Honorary Member of American Pediatric Society E-mail: sinasiozsoylu@hotmail.com Received/Geliş tarihi : June 21, 2014 Accepted/Kabul tarihi : June 23, 2014 434
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