No abstract

Congenital hemolytic anemias (CHAs) are heterogeneous and rare disorders caused by alterations in structure, membrane transport, metabolism, or red blood cell production. The pathophysiology of these diseases, in particular the rarest, is often poorly understood, and easy-to-apply tools for diagnosis, clinical management, and patient stratification are still lacking. We report the 3-years monocentric experience with a 43 genes targeted Next Generation Sequencing (t-NGS) panel in diagnosis of CHAs; 122 patients from 105 unrelated families were investigated and the results compared with conventional laboratory pathway. Patients were divided in two groups: 1) cases diagnosed with hematologic investigations to be confirmed at molecular level, and 2) patients with unexplained anemia after extensive hematologic investigation. The overall sensitivity of t-NGS was 74 and 35% for families of groups 1 and 2, respectively. Inside this cohort of patients we identified 26 new pathogenic variants confirmed by functional evidence. The implementation of laboratory work-up with t-NGS increased the number of diagnoses in cases with unexplained anemia; cytoskeleton defects are well detected by conventional tools, deserving t-NGS to atypical cases; the diagnosis of Gardos channelopathy, some enzyme deficiencies, familial siterosterolemia, X-linked defects in females and other rare and ultra-rare diseases definitely benefits of t-NGS approaches.

Maternal cbl status is an important determinant of infantile cbl status. Both maternal holoTC and tHcy may assist in predicting infantile cbl status. The finding of high prevalence of maternal and infantile cbl deficiency in this study points towards the need for effective strategies to prevent cbl deficiency in women prior to getting pregnant.

Few studies have examined the association between maternal vitamin B 12 status and their breast-fed infants' findings. The objective of this study was to analyze the association of maternal B 12 status with infant findings including neurodevelopmental outcome in breast-fed babies with B 12 deficiency. Correlation analyses between the laboratory findings of infants with B 12 deficiency (n = 120) and their mothers were performed and the association of maternal B 12 status with infant findings including the Denver-II developmental screening test (DDST II) results was examined. There was a significant correlation between infant and maternal B 12 levels (r = 0.222; P = 0.030), and between infant and maternal homocysteine (Hcy) levels (r = 0.390; P < 0.001). Among the babies 4 months of age or older, maternal Hcy levels were significantly correlated with infant mean corpuscular hemoglobin (r = 0.404; P = 0.001) and infant mean corpuscular volume (r = 0.461; P < 0.001). Mothers of infants with abnormal DDST II had lower vitamin B 12 (196.9 ± 41.2 vs. 247.0 ± 77.0 pg/mL; P = 0.018) and higher Hcy levels (17.3 ± 5.0 vs. 10.7 ± 3.1 µmol/L; P < 0.001) than mothers of infants with normal DDST II. A lower maternal vitamin B 12 status may be related to impaired neurodevelopment in breast-fed infants with vitamin B 12 deficiency. Pregnant and lactating women should be offered easy access to healthy nutrition and vitamin B 12 supplements.

The diagnosis of mild bleeding disorders is not easy as most of the "healthy" individuals also report bleeding symptoms. In order to get a precise bleeding history, Pediatric Bleeding Questionnaire (PBQ) has been developed. In our study, Turkish children diagnosed with Von Willebrand disease (VWD), platelet function defect (PFD), and healthy children without any symptoms (control group 1) and healthy children with symptoms but found hemostatically normal (control group 2) were analyzed with PBQ. The cut off level for "positive bleeding score" was found to be ≥2 (area under the curve [AUC]: 0.785, 95% confidence interval [CI]: 0.718-0.852). The sensitivity, specificity, positive predictive value, and negative predictive value of PBQ to define VWD versus control group 1 was 100%, 97.4%, 96.4%, and 100%; VWD versus control group 2 was 100%, 53.1%, 64.3%, and 100%; PFD versus control group 1 was 93.3%, 53.1%, 73.7%, and 85%; and PFD versus control group 2 was 93.3%, 53.1%, 73.7%, and 85%, respectively.

Amaç: Hemofili A (HA), faktör 8 (F8) genindeki hemizigot mutasyonların neden olduğu X'e bağlı kalıtsal kanama bozukluğudur. Bu çalışmanın amacı, Türkiye'den büyük bir HA kohortunda F8 geninin mutasyon spektrumunu belirlemek ve fenotip-genotip korelasyonu oluşturmaktır. Gereç ve Yöntemler: Mart 2017-Mart 2018 tarihleri arasında Ege Üniversitesi Pediatrik Genetik Moleküler Laboratuvarı'nda moleküler olarak analiz edilen tüm HA hastaları (270 hasta) çalışmaya dahil edildi. "İntron 22 inversiyonu" (Inv22), "intron 1 inversiyonu" (Inv1), "küçük delesyon/duplikasyonlar" ve "nokta mutasyonları" tanımlamak için F8'in moleküler analizleri, uygun bir algoritma kullanılarak gerçekleştirildi. Bulgular: Mutasyon saptama başarı oranı %95,2'ydi. Yüz altı hastada (%39,3) Inv22 pozitif, 4 hastada (%1,5) Inv1, 137 hastada (%50,6) Yüz altı farklı hastalık yapıcı sekans varyantı saptandı. On hastada (%3,7), büyük intragenik delesyonlar olduğu öngörülen bir veya daha

SUMMARYA 15-year-old boy on a vegetarian diet presented with severe macrocytic anaemia (haemoglobin, 5.1 g/dL; mean corpuscular volume, 116 fL) in addition to leucopenia and thrombocytopaenia ( pancytopenia), icterus secondary to haemolysis and splenomegaly. Laboratory investigations revealed severe vitamin B 12 (cobalamin) deficiency. Following cobalamin replacement therapy, the patient reported increased well-being, including appetite and weight gain, and his icterus resolved. In the follow-up laboratory examinations, leucocyte and platelet counts in addition to serum bilirubin and lactate dehydrogenase levels normalised. At the end of 2 months, laboratory findings, including haemoglobin level, were all within the normal range. We present this case as a reminder that severe vitamin B 12 deficiency may present with findings mimicking acute leukaemia ( pancytopenia and splenomegaly) and findings suggestive of pseudothrombotic microangiopathy. BACKGROUND

Little is known about the likelihood of curing children with high-dose chemotherapy regimens for treatment of childhood acute lymphoblastic leukemia (ALL) in Turkey. The authors here report their 13 years' experience with original ALL-BFM (Berlin-Franfurt-Münster) 95 protocol in a cohort of 140 Turkish children with ALL. Complete remission rate was 97.7% with a relapse rate of 12.9% and death rate 17.9% during a median follow-up of 69 months. The event-free survival (EFS), disease-free survival (DFS), and overall survival (OS) in these patients at 12 years were 75.0%, 87.1%, and 80.6%, respectively. These results show that ALL-BFM 95 protocol is equally applicable in the experienced centers, even in developing countries without substantial treatment-related toxicity. High rate of infection deaths are to be reduced with correct policies.