Journal of Blood & Lymph

Hepatitis B infection is the leading cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma and is thought to be responsible for million deaths per year globally. Management of patients with resolved or active hepatitis B and cancer is a challenge and these patients are at higher risk of hepatitis B related complications due to immunosuppression and loss of prior immunity. The treating hematologist needs to understand the biology of this common virus, its potential for long-term harm, the necessary laboratory monitoring for their identification and characterization, and the pharmacological interventions for their control. This review offers a general approach to prevention and treatment of hepatitis B reactivation in patients with hematological malignancies and transplant recipients. Practitioners are also encouraged to seek advice and consultation from experts in the design of specific protocols for screening, monitoring and prevention.

Introduction: Phospholipid asymmetry is well maintained in erythrocyte (RBC) membranes with phosphatidylserine (PS) exclusively present in the inner leaflet. Eryptosis, the suicidal death of erythrocytes, is characterized by cell shrinkage, membrane blebbing and cell membrane phospholipids scrambling with PS exposure at the cell surface. Erythrocytes exposing PS are recognized, bound, engulfed, and degraded by macrophages. Eryptosis thus fosters clearance of affected erythrocytes from circulating blood which may aggravate anemia in pathological conditions. Thalassemia patients are more sensitive to the eryptosis depletion and osmotic shock which may affect RBC membrane Phospholipid asymmetry.

Aim: We aimed in this work to determine the erythrocyte PS exposure in splenectomized and non splenectomized β-Thalassemia (β-TM) patients and correlate it with the clinical presentation and laboratory data.

Methods: RBCs were stained for annexin V (AV) to detect phosphatidylserine (PS) exposure in 46 β-TM patients (27 splenectomized and 19 non splenectomized) compared to 17 healthy subjects as a control group.

Results: We reported significant increase in erythrocyte PS exposure in β-TM patients compared to control group (p=0.0001). Erythrocyte PS exposure was significantly higher in splenectomized β-TM patients as compared with non splenectomized β-TM patients (p=0.001). No correlation was found between erythrocyte PS exposure and clinical or hematological data of β-TM patients but there was positive correlation between erythrocyte PS exposure and ferritin level in β-TM patients.
Conclusion: These findings suggest that β-TM patients have higher level of erythrocyte PS exposure and splenectomy was shown to aggravate erythrocyte PS exposure without aggravation of anemia.

For women with hematologic malignancy anticipating chemotherapy or radio therapy but wishing to preserve fertility, it is preferable that recovery from oophorectomy be as rapid as possible. Considering Reduced-Port Surgery (RPS) to be potentially suitable for such patients, we used RPS for a patient with malignant lymphoma scheduled for pre-bone marrow transplantation chemotherapy. The patient was a 28-year-old woman, gravida 0, who had requested fertility preservation. Thus, with ethics committee approval, the left ovary was removed by RPS, and ovarian cortex with primordial ovarian follicles was cryopreserved by vitrification. The cortex was divided into 12 pieces, 1 cm×1 cm×1 mm each, placed in a container, and stored in liquid nitrogen. The patient’s post-bone marrow transplantation course was good. Because she was judged to have lost ovarian function, ovarian back-transplantation was performed by RPS. The cortex of the remaining right ovary was removed with a laparoscopic cold knife and scissors while heparin saline was instilled to maintain blood flow and a 2 cm×1 cm base was created. Two thawed ovarian cortex pieces were laparoscopically sewed to the base with 5-0 absorbable sutures. By postoperative day 173, the ovarian follicle had increased to 10 mm in diameter, and the patient’s estradiol level had risen to 101 pg/ml, suggesting recovery of ovarian function. Our experience in this lymphoma case suggests that ovarian cryopreservation and back-transplantation for fertility preservation can be performed safely by RPS and is a viable option for selected patients anticipating chemotherapy and bone marrow transplantation for hematologic malignancy.

Acute Myelomonoblastic Leukaemia (ANLL M4) and Aplastic Anemia (AA) are rare childhood diseases. Treatment of ANLL involves chemotherapy and radiotherapy, while immunosuppressive therapy is used in the treatment of AA. In selected cases, both disorders can be treated by performing a Hematopoietic Stem Cell Transplantation (HSCT). In addition, supportive medical care which includes antibiotics, antifungal drugs, packed red cells and platelets, is usually essential due to adverse effects caused by the therapy. Herein, we present a 15- year- old boy with ANLL M4 and a 17- year- old girl suffering from Severe Aplastic Anemia (SAA) for 3 and 4 years respectively, in whom iron overload was noted after they had undergone allogeneic HSCT (allo HSCT). On further diagnosis, co-existence of S65C HFE gene carriage was identified in both of them.

Following injury, transfusion of Red Blood Cells (RBCs) of greater storage duration has been associated with anincreased morbidity and mortality. Prospective trials focusing on the impact of the storage age of RBCs in severely bleeding trauma patients have typically failed to accrue patients. This has been attributed to both inability to maintain a large inventoryof fresh RBCs, and the difficulties in obtainingconsent in severely bleeding trauma patients. To address theissue of the impact of old blood on the injury victim, we reviewed the literature on this topic.