[Impact of early lymphopenia on the risk of febrile neutropenia and hematological toxicity]

Background: Hematologic toxicity is a severe complication of chemotherapy. The objective of our study is to evaluate the impact of early lymphopenia on the risk of occurrence of febrile neutropenia and hematological toxicity after aggressive chemotherapy for Hodgkin lymphoma or high grade non-Hodgkin lymphoma

Methods: This prospective study involved 42 patients who received 193 cycles of chemotherapy in 2009. We assessed the impact of lymphopenia on day 1 and 8 on the risk of occurrence of febrile neutropenia. We also investigated the relation between the occurrence of hematologic toxicity after the first cycle and the subsequent cycles

Results: Febrile neutropenia was observed in 25% of cycles. Grade 3/4 hematologic toxicity occurred in 63% of cycles. Growth factors were used in 79% of cycles. Lymphopenia

Conclusion: Our results confirmed the impact of early lymphopenia on the occurrence of febrile neutropenia and hematologic toxicity after aggressive chemotherapy for Hodgkin lymphoma or high grade non Hodgkin lymphoma

[Monocentric study of Willebrand's disease in Tunisia: assets and difficulties]

Background: Von Willebrand's disease [VWD] is the most commonly inherited bleeding disorder. It is characterized by clinical, biological and molecular heterogeneity. In certain types of the disease, diagnosis can be difficult

Aim:We report the clinico-biological characteristics of VWD's patients and analyze diagnosis difficulties

Methods:33 cases were diagnosed in the laboratoryfrom February to May, 2011. Screening hemostasis included the measuring of FVIII: C, VWF: Ag and VWF: RCo. Blood cell count and blood group were performed in all cases

Results: Mean age at diagnosis is 13 years [10 months -43 years]. The sex ratio M/F is 0.5. The patients are classified type 3 VWD in 52% of the cases, type 2 VWD in 30% of the cases and type 1 VWD in 18% of the cases. The diagnosis of type 2B VWD suspected in combination of the ratio VWF:RCo / VWF: Ag <0,7 and thrombocytopenia in one case. Required tests for positive diagnosis and distinction between the primary categories of VWD are available. Specialized tests will allow a best characterization variants type 2 VWD for a better therapeutic approach

[Quality of life during menstruation in women with an inherited bleeding disorder: a 31 cases study]

Menstruations, by their abundance and their duration, can be a source of impaired quality of life. Women with inherited bleeding disorders appear to be, specially at risk. Assess the impact of menstrual blood loss on the quality of life for women with inherited bleeding disorders. 31 women with various inherited bleeding disorders were interviewed. They completed a quality of life questionnaire. Von Willebrand disease was the most frequent inherited bleeding disorder in our population [38.7%]. 54.8% of patients had a menstrual period more than 6 days 61.3% of them consider their menstrual flow to be normal. The general condition apart of the menstrual period was considered medium to poor in 35.5% of patients. The average score assessing the impact of menstruation on daily life was of 5.00 +/- 3.47. Only 19.35% of patients felt that dysmenorrhea significantly affect their quality of life. Impaired quality of life was seen in 64.5% of patients according to score A and in 41.9% of them according to score B. During menstruation 22.6% of the patients didn't do to work or to school because of the menstrual flow. On the other hand, 48.4% of patients were hospitalized at least once for a heavy menstrual flow. The quality of life during menstruation, in women with an inherited bleeding disorder, according to the different scores appear altered. Although because of the small size of our study population, we could not prove correlation between the importance of menstrual blood loss and the impairment of quality of life

[Dysfibrinogenemia and thrombosis. A case report]

Congenital dysfibrinogenemia is a functional disorder of the fibrinogen that represents a rare cause of thrombophilia. To report a Tunisian case of the association dysfibrinogenemia and thrombosis. A woman with ingerited dysfibrinogenemia associated with mild tendency to bleeding experienced a deep vein thrombosis of the lower-extremity at 26 years of age and a fatal pulmonary embolism a few years later. Paradoxically coagulation function of fibrinogen was markedly altered in vitro with a significally prolonged prothrombin time, activated partial thromboplastin time and thrombin time, a functional fibrinogen level that was undetected and a severely impaired fibrin polymerization. The thromboembolic events in the patient could be related to dysfibrinogenemia since the main causes of thrombophilia were excluded. Although it is rare, this cause of thrombophilia must be misdiagnosed, systematic measuring of prothrombin time, activated partial thromboplasting time and functional fibrinogen might be helpful

[Bacteriological profile of urinary tract infections in women in Aziz Othmana hospital: a 495 cases study]

Urinary infection is a frequent pathology in the community as well as at the hospital. To analyze the profile of bacteria isolated from urinary tract infectious in women and their antimicrobial resistance. During two year period [1 January 2005 to 31 December 2006], 4536 urinary specimens were analyzed at the Laboratory of Aziza Othmana Hospital. All bacteria isolated from urinary tract infection [UTI] at women were retrospectively reviewed. 495 cases of UTI were collected during this period. They were recovered from out patients [67%] or from hospitalized patients in Gynecology and obstetrics [23%]. Enterobacteriacae were the most frequently identified strains [90.4%] including Escherichia coli [71%]. The identified strains presented natural resistance and a high frequency of acquired resistance to betalactams[60.3% of E.coli, 72% of P.mirabilis were resistant to amoxicillin]and cotrimoxazole[30.4% of E.coli, 19,1 of K.pneumoniae, 21.4% of P.mirabilis]. 5.7% of K.pneumoniae and 1.8% of E.coli were producing extended spectrum betalactamase[ESBL]. Aminoglycosides remained active on enterobacteriacae[resistance to amikacin<14%,gentamicin<5%].Ofloxacin was highly active against enterobacteriacae [resistance <14%]. Enterobacteriacae were the most frequent species in women urinary tract infection. Among these isolates, a high frequency of acquired resistance to betalactams and cotrimoxazole was shown. Aminoglysosides and fluoroquinolones remained the most active drugs. In every case antibiotherapy should have been prescribed after performing an antibiogram for each strain. These data were useful for the first line antibiotherapy, however the antimicrobial susceptibility testing is necessary for the rational use to limit the highly active drugs to multiresistant strains

[Beta thalassemia intermedia: about 36 cases]

Thalassemia intermedia empasses a mild clinical and biological spectrum. The aim is to report the clinical and biological features and treatment of this disease. It is a retrospective study about 36 thalassemia intermedia patients [17 males, 19 females]. Epidemiological, haematological aspects and treatment were reported. The diagnosis was carried out at a relatively old age 15 years [1-72].The thalassemia intermedia was characterized by mild facial deformities, splenomegaly and moderate anemia [Hb=9.1 g/dl]. The mean serum ferritin was 518 ng/ml [25-1800].Three phenotypes are caracterised: heterozygosis beta thalassemia, beta° thalassemia and beta° thalassemia. Clinical complications were hypersplenism, extra medullary hematopoiesis, leg ulcers, thrombosis and pulmonary hypertension. Treatment was based on occasionally transfusion and splenectomy on event of hypersplenious [47%]. Evolution of this disease was generally good with a long lifespan at 31 years [6-83]. Thalassemia intermedia is well tolerated. Transfusions and splenectomy were indicated in case of hypersplenious

[Surveillance of multidrug resistant bacteria in a Tunisian hospital]

Controlling antibiotic resistance of bacteria is a priority for public healthcare. This study concerned the frequency of multidrug resistant bacteria [MDRB] in a Tunisian Hospital with the aim of establishing guidelines for MDRB prevention. The study was conducted during two years [1 January 2005-31 December 2006]. Samples collected for the clinical diagnostic were included. The MDRB concerned were: methicillin resistant Staphylococcus aureus [MRSA], Enterobacteriacae resistant to of third generation cephalosporin [ER3GC]. Acinetobacter baumannii resistant to both imipenem and ceftazidime, Pseudomonas aeruginosa resistant to both imipenem and ceftazidime. During the study period, 2475 bacteria were tested by disk diffusion. 597 MDRB were collected, the rate of MBR was 24.1%. These MDRB were mainly recovered in burn unit [82.6%]. ER3GC [47%] and MRSA [29, 2%] were the most frequent MDRB. A. baumannii and P. aeruginosa multiresistant concerned 4, 8% and 9% of MDRB. MDRB were isolated mainly from blood cultures [45%]. The rate of MRSA was 46.4% among 375 strains of S. aureus. ER3GC represented 25, 6% among 1096 isolates. Concerning A. baumannii and P. aeruginosa, 51.7% and 20.5% were resistant to both imipenem and ceftazidime among 170 and 264 isolates. Antiobiotic resistance evolution showed a decrease of resistance in 2006 versus 2005. This decrease should be explained by the improvement of hygiene measure especially hand washing with the introduction of hydro- alcoholic solutions, a better targeted antibiotherapy promoved by a close cooperation between microbiologists and clinicians. The MDRB were frequent in our hospital. They were mainly isolated from the burn department. The measures of prevention already implemented are effective and must be strengthened with the continuous surveillance of MDRB

Sweet syndrome in my myeloid malignancy

Sweet's syndrome is an acute febrile neutrophilic dermatosis. This condition is characterized by the sudden onset of fever and tender, erythematous, well-demarcated papules which show dense neutrophilic infiltrates on histological examination. Sweet's syndrome is often associated with hematologic disease including myeloid leukemia. Aim: Report of news cases of Sweet's syndrome. We report two cases of Sweet's syndrome occurring respectively after the use of Granulocyte-Colony Stimulating Factor [G-CSF], and the All-Trans-Retinoic-Acid [ATRA] in two females aged respectively 46 and 35 years. The outcome was favourable in the two cases

Bacterial flora and antibiotic resistance in a clinical haematology unit

Infections are among the most serious complications in neutropenic patients and are associated with an increased morbidity and mortality. Ongoing surveillance of infection in neutropenic patients is essential to detect changes in epidemiology and to guide better empirical antibiotic regimens and infection control policies. The aim of this study is to analyze the bacterial flora and the antibiotic resistance of isolates in a clinical haematology unit during three years period. From 1 January 2003 to 31 December 2005, 437 strains were isolated from different specimens. Antimicrobial susceptibility testing has been carried out by disk diffusion method as referred to the French Society of Microbiology. All susceptibility data were stored in a laboratory data base using Whonet software. Duplicate isolates defined as the same bacterial species for the same patient with the same profile of susceptibility were excluded. Gram negative bacilli [GNB] rate was 47.1% and Gram positive cocci [GPC] rate 52.9%.The most frequently identified species were coagulase negative staphylococci [CNS]: 29.3%, Escherichia coli:14%, Staphylococcus aureus: 10.7%, Klebsiella pneumoniae: 9.1% and Pseudomonas aeruginosa:7.5%. The global rate of methicillin resistant staphylococci was 27.7% for S. aureus and 61.4% for CNS, no GISA [glycopeptide intermediate S.aureus] was detected during the study period. For E. coli, the frequencies of resistance to ceftazidime, ciprofloxacin and amikacin were respectively: 45%, 26. 3% and 21.3%.Concerning K. pneumoniae, 84, 8% of strains were resistant to ceftazidime and were producing extended spectrum,-lactamase [BLSE]. The trends of resistance showed an increasing rate of K. pneumoniae BLSE: 57.1% in 2003 versus 95.5% in 2005. However; all isolates remained susceptibles to imipenem and colistin. Concerning P. aeruginosa, 50% were resistant to ceftazidime, 50% to imipenem, 51.6% to ciprofloxacin and 54.5% to amikacin. An increasing rate of imipenem resistance in P. aeruginosa was observed from 2003 to 2005[28. 6% in 2003 versus 45. 5% in 2005]. Following this study, a restriction use of ceftazidime [substituted by piperacillin-tazobatam] was instaured in the unit. A further study should be conducted to evaluate the impact of piperacillin-tazobactam as a first line treatment in neutropenic patients

Cytology and immunophenotype feautures of 80 acute myeloid leukemia

Acute myeloid leukemia [AML]'s diagnosis is clinical and biological. We report here 80 AML with cytology and immunophenotype features to establish correlations. 21 AML1, 23 AML2, 12 AML3, 2 AML4, 18AML5 and 3 AML6 were diagnosed by cytology. Only one case of AMLO was diagnosed by immunophenotype. Myelogysplasia is present in 29,8% cases. CD 19 and CD56 expression was significantly associated to AML +t[8;21]. Additionally, concomitant negativity of CD34 and HLA-DR was dis-crimininatif to AML3 diagnosis. Prognostic value to expression some CD needs time backwards

[Alpha interferon in children with philadelphia chromosome-positive chronic myeloid-leukaemia]

The present work focuses on the therapeutic efficacy and the toxicity of alpha interferon in patients younger than age 18 years. 5 patients younger than 18 years were treated and followed up between 1990 and 1999 at the department of haematology [Aziza Othmana Hospital] Hydroxyurea was given as initial treatment to all patients. After a median period of 8 months. these patients received alpha interferon [5 millions units/m 2 once]. Six months after the beginning of the alpha interferon a complete hematologic response was obtained in all patients. The median overall survival was of 66 months: 3 patients are still alive [2 patients in an advanced stage and one patient in chronic phase] and 2 patients died after transformation. The most common reported side effects of alpha interferon were asthenia, weight loss, fever, myalgia, chills and headaches - these toxic manifestations were mild and were noticed in all our patients. MyeIosuppression was noted in two patients. Interferon is well tolerated in patients younger than age years 18 old, with CML.It may offer an alternative to bone marrow transplantation in children in the chronic phase of CML without histocompatible donor. The role of new agents such as STI 571 needs to be evaluated as well

[Long term survival and prognostic factors in multiple myeloma treated with conventional chemotherapy. About 109 cases]

Our study is retrospective. We report the results of conventional chemotherapy in previosly untreated patients with myeloma. Survival and progonstic factors were analysed in 109 patients diagnosed from 1983 to 1992. The median age was 65 years, 87 patients [80%] were including in the stage III according the Durie Salmon staging system. The median survival time was 27 months and 10 years survival rate is 3,66%. In the univariate analysis, two prognostic variables were retained namely the hemoglobin and creatinine level. The study suggest that conventional therapy is agood treatment for old patients. However, patients younger than 55 years, must benefit from intensive chemotherapy supported by autologus bone marrow, pheripherol blood stem cells, or allogenic bone marrow transplantation. A considerable encrace in duration of remission and survival is possible

Resultats d'un protocole prospectif de traitement de la maladie de hodgkin de l'adulte

To report the results of an adapted protocol of treatment of Hodgkin disease in Tunisian patients. 70 patients[47 males and 23 females, sex-ratio=2,04] with a mean age of 38,5 years [15 to 75] are enrolled in a therapeutic protocol to the prognostic factors and based on chemotherapy with MOPP/ABV or hybrid associated to radiotherapy. We perform an evaluation of response to chemotherapy after the 4th cycle, after the 6th cycle and then at the end of the protocol. Our population is characterized by the frequency of young patients [34% between 30 and 40 years], Histologic types 2 and 3 [45 and 48%] and advanced disease with 60% of stages III and IV. After the 4th cycle, 32 patients [45%] are in complete response and 31[44%] in partial response, while 6 patients [9%] progress under chemotherapy. After 6 cycles, we observe 44 in complete response[72%] including 46% of the bad responders after 4 cycles. At the end of the protocol and on the 58 evaluable patients, 50 remain in complete response [86%]. We observe 5 deaths occurred in 3 progressing patients and in 2 patients by infection after chemotherapy. 5 year actuarial and disease-free survival is 60% and 56% and median survival is 83 months. In the univariate analysis, response to chemotherapy represent the unic significant prognostic factor