Case report: Pancytopenia as a rare presentation of Sheehan's syndrome.

Sheehan's syndrome is a postpartum hypopituitarism state caused by necrosis of the pituitary gland. It is usually the result of severe hypotension or shock caused by massive hemorrhage during or after delivery. Sheehan's syndrome symptoms are often subtle and hence it is diagnosed late. Herein, we report a case of a 41-year-old woman who developed severe postpartum hemorrhage after childbirth that required a total abdominal hysterectomy to control bleeding at the age of 36 years. Since then, she has progressively developed symptoms of headache, general fatigue, and malaise, and finally presented with pancytopenia for investigations. Anemia is a well-known hematological association with Sheehan's syndrome while pancytopenia is rarely reported. However, complete recovery of pancytopenia was observed after the treatment. Pancytopenia (due to bone marrow failure to produce cells) is a serious finding in clinical practice that causes significant stress as it may point to a diagnosis of malignancy (mainly leukemia) and other serious disorders. Despite being a rare cause, a high index of suspicion is required from the physicians in women with pancytopenia, in order to look for a possible treatable cause of pancytopenia (like Sheehan's syndrome), if the common causes were excluded.

Study of Frequency and Characteristics of Red Blood Cell Alloimmunization in Thalassemic Patients: Multicenter Study from Palestine.

Background. ß-Thalassemia is a common inherited hemolytic disorder in Palestine. Red blood cell (RBC) transfusion is the principal treatment but it may cause RBC alloimmunization. This study was conducted to determine the prevalence and characteristics of RBC alloimmunization among thalassemic patients in northern governorates of Palestine. Methods. A prospective multicenter observational study was conducted in the thalassemia transfusion centers in the northern governorates of Palestine. The study included 215 thalassemia patients who received regular blood transfusions. Clinical and transfusion records of patients were examined. Antibody screening and identification was conducted using the microcolum gel technique. Results. Two hundred fifteen patients were included in the study. More than half (52.1%) of the patients were males. The median age of patients was 18 years (range: 12-24 years). The most frequent blood group was A (40.5%). Alloantibodies were detected in 12.6% of patients. Anti-D (33.3%), anti-K (25.9%) and anti-E (14.8%) were the most commonly isolated antibodies. There was no association between age, sex, starting age of transfusion, number of transfused units, history of splenectomy and alloimmunization. Conclusions. Anti-Rh and anti-K antibodies were common among this cohort of patients. Age, sex, starting age of transfusion, number of transfused units, and history of splenectomy could not predict the occurrence of alloimmunization.

Relaxometric, Optical and Cell Viability Properties of D-Glucuronic Acid Coated Cr2O3 Nanoparticles.

D-glucuronic acid-coated ultrasmall chromium oxide (Cr2O3) nanoparticles were synthesized by a one-pot polyol method and their relaxometric and optical properties were investigated. The as-synthesized D-glucuronic acid-coated nanoparticles were amorphous owing to ultrasmall particle diameters (davg = 2.0 nm), whereas orthorhombic Cr2O3 nanoparticles with two size groups (davg = 3.6 and 5.7 nm) were observed after thermogravimetric analysis (900 °C) as a result of particle growth. The nanoparticles exhibited size-dependent UV-visible absorption maxima at 238, 274, and 372 nm with increasing particle diameter, corresponding to band gaps of 5.13, 4.45, and 3.28 eV, respectively. D-glucuronic acid-coated ultrasmall Cr2O3 nanoparticles revealed low water proton relaxivities of r1 = 0.05 s-1mM-1 and r2 = 0.20 s-1mM-1, consistent with the antiferromagnetic property of Cr2O3. They showed good biocompatibility up to 500 µM of Cr.

Red blood-cell alloantibodies in multiply transfused patients in the occupied Palestinian territory: a pilot study.

BACKGROUND: Red blood-cell transfusion has greatly reduced the mortality and morbidity in multiply transfused patients with thalassaemia and sickle cell disease. However, this can result in red blood-cell isoimmunisation with autoantibodies and alloantibodies, which can lead to serious complications such as delayed haemolytic transfusion reaction. The aim of this study was to assess the frequency and types of alloantibodies in multiply transfused patients living in the north of the West Bank. METHODS: This pilot study was done at three thalassaemia centres in Nablus, Jenin, and Tulkarm in the occupied Palestinian territory where 300 patients with thalassaemia and sickle cell anaemia regularly receive blood transfusions. Alloantibody screening and identification were done using three-cell and eleven-cell panels (DiaPanel, Bio-rad, Switzerland) respectively. Ethical approval was obtained from Institutional Review Board Centre at Najah University. Written consent was obtained from participants. FINDINGS: 131 patients were enrolled. Of the 20 (15%) patients with alloantibodies, 14 (70%) were diagnosed with ß-thalassaemia major, three (15%) were diagnosed with sickle cell anaemia, two (10%) were diagnosed with thalassaemia intermedia, and one (5%) was diagnosed with sickle cell thalassaemia. 13 (65%) patients had alloantibodies that belonged to the Rh blood group system (nine [45%] patients had anti-D; two [10%] had anti-E; one [5%] had anti Rh-C; and one [5%] had anti-c). Anti-Kell was found in seven (35%) patients. INTERPRETATION: Our data showed a quite high prevalence of alloimmunisation in multiply transfused patients. Rh and Kell blood group system antibodies were the only alloantibodies identified in this study. To reduce alloimmunisation, it will be essential to introduce a policy for extended red blood-cell phenotyping of these patients and for the issuing of antigen-matched blood (at least for Rh and Kell antigen). FUNDING: Najah National University.

Stable and non-toxic ultrasmall gadolinium oxide nanoparticle colloids (coating material = polyacrylic acid) as high-performance T 1 magnetic resonance imaging contrast agents.

For use as positive (T 1) magnetic resonance imaging contrast agents (MRI-CAs), gadolinium oxide (Gd2O3) nanoparticle colloids (i.e. nanoparticles coated with hydrophilic ligands) should be stable, non-toxic, and ultrasmall in particle diameter for renal excretion. In addition, they should have a high longitudinal water proton relaxivity (r 1) and r 2/r 1 ratio that is close to one (r 2 = transverse water proton relaxivity) for high-performance. In this study, we report ultrasmall Gd2O3 nanoparticle colloids [coating material = polyacrylic acid, M w = ∼5100 Da] satisfying these conditions. The particle diameter was monodisperse with an average value of 2.0 ± 0.1 nm. The colloidal suspension exhibited a high r 1 value of 31.0 ± 0.1 s-1 mM-1 and r 2/r 1 ratio of 1.2, where r 1 was ∼8 times higher than that of commercial Gd-chelates: the cooperative induction model was proposed to explain this. The effectiveness of the colloidal suspension as a high-performance T 1 MRI-CA was confirmed by taking in vivo T 1 MR images in a mouse after intravenous administration. Highly positive contrast enhancements were observed in various organs of the mouse such as the liver, kidneys, and bladder. The colloidal suspension was then excreted through the bladder.