A large case series on surgical outcomes in congenital factor XIII deficiency patients in Iran.

Essentials Data on surgery in factor XIII (FXIII) deficiency patients are scarce and lack standardized guidelines. Variable dosage of 10-50 U kg-1 was given to FXIII deficiency patients undergoing surgery. Surgical outcomes showed excellent hemostasis with a minimal risk of post-operative complications. Surgery can be performed safely in FXIII deficiency patients following FXIII administration. SUMMARY: Background The lack of accepted standardized surgical guidelines leads to dependence on the treating physicians' and centers' experiences. Aim Our aim is to evaluate the surgical outcomes of a large group of congenital factor XIII deficiency (FXIIID) patients. Methods A case series study was conducted prior to surgery on congenital FXIIID patients in two major referral centers located in Iran from 2010 to 2016. All patients were on prophylaxis using plasma factor XIII concentrate (10 U kg-1 , every 28 days) except for three patients. Single doses of 10 U kg-1 or 30 U kg-1 plasma factor XIII concentrate were given before a minor procedure and circumcision, respectively. Two doses of plasma factor XIII concentrate, one 30 U kg-1 prior to the procedure and the second dose of 30 U kg-1 on postoperative day 3, were given for major surgery. The dose was 50 U kg-1 both before and after neurosurgical procedures. Results One hundred and sixty-two FXIIID patients underwent minor, major and obstetrical/gynecological surgeries. Median age of the patients was 14 years (ages ranged 15 days to 47 years). The male-to-female ratio was 89/73. Five postoperative complications, two bleeding and three thrombosis, were recorded. Conclusion Our study showed excellent hemostasis in FXIIID patients undergoing surgeries. During the period of these surgeries, we observed only 1.8% postoperative complications. Surgery can be performed safely in FXIIID patients, and our proposed treatment regimens lead to adequate hemostatic coverage with minimal risk, for both minor and major surgeries.

Rituximab efficacy in the treatment of children with chronic immune thrombocytopenic purpura.

BACKGROUND: There are several medications for treatment of immune thrombocytopenic purpura (ITP), including corticosteroids, intravenous immunoglobulin, immunosuppressive drugs, and even splenectomy. In case of failure, Rituximab as one of the medications used in these patients should be considered. METHOD: This Case--series study was conducted prospectively in patients who were referred to Hematology & Oncology Clinic of Ali Asghar Hospital. Eighteen Patients were followed up for at least 3-5 years. RESULTS: Four weeks after treatment, only in 6 patients (33/3%) of 18 patients, complete response (Plt > 100,000) were obtained and most patients (67/66%) had no appropriate response. In subsequent surveys conducted at 6 and 36 months after treatment, the percentage of patients responding fell to 22/2% hit. CONCLUSION: The results of this study demonstrate proper safety of Rituximab in the treatment of chronic ITP. However, the drug had no significant effect on the expected improvement in platelet count of patients. It seems that monotherapy is ineffective in the treatment of chronic ITP and combination with other complementary therapies is recommended.